HEALTH ECONOMICS & REIMBURSEMENT
AMBULATORY SURGICAL
CENTER (ASC) & OFFICE
BASED LAB (OBL)
REIMBURSEMENT GUIDE
Effective Dates: January 1, 2024 to December 31, 2024
VASCULAR
PHYSICIAN REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
ILIAC ARTERY REVASCULARIZATION | |||
37220 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty | $381 | $2,411 |
37221 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed | $469 | $2,960 |
+37222 | Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) | $176 | $595 |
+37223 | Revascularization, endovascular, open or percutaneous, iliac 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) | $202 | $1,221 |
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION | |||
37224 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty | $424 | $2,803 |
37225 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed | $570 | $8,404 |
37226 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed | $494 | $7,785 |
37227 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed | $682 | $10,732 |
TIBIAL/PERONEAL ARTERY REVASCULARIZATION | |||
37228 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty | $515 | $3,972 |
37229 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed | $660 | $8,551 |
37230 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed | $660 | $8,565 |
37231 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed | $699 | $11,308 |
+37232 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) | $190 | $790 |
+37233 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | $306 | $1,015 |
+37234 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | $268 | $3,492 |
+37235 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | $350 | $3,794 |
TRANSLUMINAL BALLOON ANGIOPLASTY | |||
37246 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery | $332 | $1,746 |
+37247 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) | $165 | $568 |
37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein | $283 | $1,302 |
+37249 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) | $139 | $426 |
ARTERIAL MECHANICAL THROMBECTOMY | |||
37184 | Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharma- cological thrombolytic injection(s); initial vessel | $411 | $1,645 |
+37185 | Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological 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) | $155 | $457 |
+37186 | Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechani- cal thrombectomy (List separately in addition to code for primary procedure) | $232 | $1,140 |
VENOUS MECHANICAL THROMBECTOMY | |||
37187 | Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural phar- macological thrombolytic injections and fluoroscopic guidance | $375 | $1,626 |
37188 | Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy | $268 | $1,393 |
THROMBOLYSIS | |||
37211 | Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day | $369 | NA |
37212 | Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day | $322 | NA |
37213 | Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subse- quent day during course of thrombolytic therapy, including follow-up catheter contrast injec- tion, position change, or exchange, when performed | $220 | 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 | $116 | NA |
EMBOLIZATION/CATHETER ACCESS | |||
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 (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) | $407 | $4,441 |
37242 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) | $453 | $6,788 |
37243 |
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction | $532 | $8,226 |
37244 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation | $628 | $6,284 |
36140 | Introduction of needle or intracatheter, upper or lower extremity artery | $85 | $494 |
36160 | Introduction of needle or intracatheter, aortic, translumbar | $118 | $533 |
36200 | Introduction of catheter, aorta | $133 | $572 |
36245 | Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family | $225 | $1,195 |
36246 | Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family | $242 | $805 |
36247 | Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family | $284 | $1,367 |
PHYSICIAN REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
EMBOLIZATION/CATHETER ACCESS (CONT’D) | |||
+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) | $46 | $112 |
DIAGNOSTIC ANGIOGRAPHY LOWER EXTREMITY | |||
75710 | Angiography, extremity, unilateral, radiological supervision and interpretation | $80* | $147 |
75716 | Angiography, extremity, bilateral, radiological supervision and interpretation | $89* | $160 |
DIALYSIS CIRCUIT | |||
36901 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report | $160 | $681 |
36902 | … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty | $229 | $1,163 |
36903 | … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment | $301 | $4,076 |
36904 | Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s); | $351 | $1,740 |
36905 | … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty | $421 | $2,189 |
36906 | … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment | $486 | $5,188 |
+36907 | Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure) | $139 | $567 |
+36908 | Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure) | $197 | $1,360 |
+36909 | Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure) | $192 | $1,818 |
+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 (List separately in addition to code for primary procedure) | $118 | NA |
CPT‡ Code 34713 is applicable only for aortic and iliac artery repair procedures using an endograft. The code may be listed twice for bilateral procedures. This will result in a total payment of 150% of the base payment rate (National Average Payment = $177.00).
It is incumbent upon the physician to determine which, if any modifiers should be used first.
NA: There is no established Medicare payment in this setting.
(+) = Indicates add-on code. List add-on code separately in addition to code for primary procedure.
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
PCI PROCEDURES | |||
92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | $506 | NA |
+92921 | Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) | No separate payment | No separate payment |
92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | $563 | 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 addition to code for primary procedure) | No separate payment | No separate payment |
C9600 | Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | See 92928 for payment | NA |
+C9601 | Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) | No separate payment | No separate payment |
93454 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; | $228* | $875 |
93455 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography | $266* | $976 |
93456 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization | $297* | $1,089 |
93457 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization | $333* | $1,187 |
93458 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when per- formed | $281* | $1,007 |
93459 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | $319* | $1,083 |
93460 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | $356* | $1,202 |
93461 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | $394* | $1,326 |
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
ANGIOGRAPHY WITH OCT IMAGING AND PHYSIOLOGY ASSESSMENT* | |||
C7516 | Coronary angiography with IVUS or OCT | NA | NA |
C7521 | Right heart catheterization with IVUS or OCT | NA | NA |
C7522 | Right heart catheterization with “flow reserve” | NA | NA |
C7523 | Left heart catheterization with IVUS or OCT | NA | NA |
C7524 | Left heart catheterization with “flow reserve” | NA | NA |
C7525 | Coronary angiography in graft with left heart catheterization with IVUS or OCT | NA | NA |
C7526 | Coronary angiography in graft with left heart catheterization with “flow reserve” | NA | NA |
C7527 | Coronary angiography with right and left heart catheterization with IVUS or OCT | NA | NA |
C7528 | Coronary angiography with right and left heart catheterization with “flow reserve” | NA | NA |
C7529 | Coronary angiography in graft with right and left heart catheterization with “flow reserve” | NA | NA |
* These codes only apply to the ASC site of service and do not impact physician reimbursement.
ASC REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
ILIAC ARTERY REVASCULARIZATION | ||
37220 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with trans- luminal angioplasty | $3,275 |
37221 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed | $6,772 |
+37222 | Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac ves- sel; with transluminal angioplasty (List separately in addition to code for primary procedure) | No separate payment |
+37223 | Revascularization, endovascular, open or percutaneous, iliac 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) | No separate payment |
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION | ||
37224 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty | $3,452 |
37225 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed | $11,695 |
37226 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed | $7,029 |
37227 | Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed | $11,873 |
TIBIAL/PERONEAL ARTERY REVASCULARIZATION | ||
37228 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty | $6,333 |
37229 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed | $11,096 |
37230 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed | $10,735 |
37231 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed | $11,981 |
+37232 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) | No separate payment |
+37233 |
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | No separate payment |
TIBIAL/PERONEAL ARTERY REVASCULARIZATION (CONT’D) | ||
+37234 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | No separate payment |
+37235 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | No separate payment |
TRANSLUMINAL BALLOON ANGIOPLASTY | ||
37246 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery | $3,280 |
+37247 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) | No separate payment |
37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein | $2,526 |
+37249 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) | No separate payment |
ARTERIAL MECHANICAL THROMBECTOMY | ||
37184 | Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel | $10,116 |
+37185 | Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological 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) | No separate payment |
+37186 | Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure) | No separate payment |
VENOUS MECHANICAL THROMBECTOMY | ||
37187 | Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance | $7,269 |
(+) = Indicates add-on code. List add-on code separately in addition to code for primary procedure.
No Separte Payment expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private
payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
VENOUS MECHANICAL THROMBECTOMY (CONT’D) | ||
37188 | Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy | $2,568 |
THROMBOLYSIS | ||
37211 | Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day | $3,658 |
37212 | Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day | $1,964 |
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 | 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 | NA |
EMBOLIZATION/CATHETER ACCESS | ||
37241 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intra- procedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) | $6,108 |
37242 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) | $11,286 |
37243 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intrapro- cedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction | $4,848 |
37244 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intra- procedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation | NA |
36140 | Introduction of needle or intracatheter, upper or lower extremity artery | No separate payment |
36160 | Introduction of needle or intracatheter, aortic, translumbar | No separate payment |
36200 | Introduction of catheter, aorta | No separate payment |
36245 | Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family | No separate payment |
36246 | Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family | No separate payment |
36247 | Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family | No separate payment |
+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) | No separate payment |
DIAGNOSTIC ANGIOGRAPHY | ||
75710 | Angiography, extremity, unilateral, radiological supervision and interpretation | NA |
75716 | Angiography, extremity, bilateral, radiological supervision and interpretation | NA |
DIALYSIS CIRCUIT | ||
36901 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report | $554 |
36902 | … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty | $2,526 |
36903 | … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imag- ing and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment | $6,931 |
36904 | Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s); | $3,223 |
36905 | … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radio- logical supervision and interpretation necessary to perform the angioplasty | $6,106 |
36906 | … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment | $11,288 |
+36907 | Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, includ- ing all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure) | No separate payment |
+36908 | Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure) | No separate payment |
+36909 | Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure) | No separate payment |
+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 (List separately in addition to code for primary procedure) | No separate payment |
ASC REIMBURSEMENT FOR CORONARY PROCEDURES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
PCI PROCEDURES | ||
92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | $3,413 |
+92921 | Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) | No separate payment |
92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | $6,616 |
+92929 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) | No separate payment |
C9600 | Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | $6,706 |
+C9601 | Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) | No separate payment |
93454 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; | $1,633 |
93455 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography | $1,633 |
93456 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization | $1,633 |
93457 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization | $1,633 |
93458 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | $1,633 |
93459 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | $1,633 |
93460 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | $1,633 |
93461 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | $1,633 |
ANGIOGRAPHY WITH OCT IMAGING AND PHYSIOLOGY ASSESSMENT | ||
C7516 | Coronary angiography with IVUS or OCT | $2,526 |
C7521 | Right heart catheterization with IVUS or OCT | $2,526 |
C7522 | Right heart catheterization with “flow reserve” | $2,526 |
C7523 | Left heart catheterization with IVUS or OCT | $2,526 |
C7524 | Left heart catheterization with “flow reserve” | $2,526 |
C7525 | Coronary angiography in graft with left heart catheterization with IVUS or OCT | $2,526 |
C7526 | Coronary angiography in graft with left heart catheterization with “flow reserve” | $2,526 |
C7527 | Coronary angiography with right and left heart catheterization with IVUS or OCT | $2,526 |
C7528 | Coronary angiography with right and left heart catheterization with “flow reserve” | $2,526 |
C7529 | Coronary angiography in graft with right and left heart catheterization with “flow reserve” | $2,526 |
CARDIAC RHYTHM MANAGEMENT
PHYSICIAN REIMBURSEMENT FOR PACEMAKERS
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
SYSTEM IMPLANT OR REPLACEMENT | |||
33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | $439 | NA |
33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | $461 | NA |
33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | $499 | NA |
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT) | |||
33227 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system | $328 | NA |
33228 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system | $343 | NA |
SYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER | |||
33214 | Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) | $463 | NA |
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT) | |||
33233 | Removal of permanent pacemaker pulse generator only | $227 | NA |
GENERATOR IMPLANT | |||
33212 | Insertion of pacemaker pulse generator only; with existing single lead | $313 | NA |
33213 | Insertion of pacemaker pulse generator only; with existing dual leads | $327 | NA |
RELOCATION OF SKIN POCKET | |||
33222 | Relocation of skin pocket for pacemaker | $333 | NA |
LEAD PROCEDURES | |||
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | $359 | NA |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | $357 | NA |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | $300 | NA |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator | $377 | NA |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator | $369 | NA |
33234 | Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular | $467 | NA |
33235 | Removal of transvenous pacemaker electrode(s); dual lead system | $614 | NA |
PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
PACEMAKER/CRT-P DEVICE MONITORING – IN PERSON | |||
93279 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber | $30* | $66 |
93280 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system | $35* | $77 |
93281 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system | $40* | $82 |
93288 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system | $20* | $55 |
93286 | Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system | $14* | $44 |
93293 | Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days | $14* | $43 |
PACEMAKER/CRT-P DEVICE MONITORING – REMOTE | |||
93294 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional | $28 | $28 |
93296 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | NA | $21 |
ICD/CRT-D DEVICE MONITORING – IN PERSON | |||
93282 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system | $39* | $78 |
93283 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system | $53* | $95 |
93284 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system | $58* | $103 |
93296: The physician practice may only bill the technical service if the physician personally performs the technical service or employs the staff member who performs the technical service. If a device industry representative is involved in performing the technical service under the physician’s direction, then the physician may only bill the professional service, i.e., physician analysis, review(s) and reports(s).
*The National Facility rates shown with an * reflect payment when modifier 26 is used (i.e. payment only for the professional component).
PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
ICD/CRT-D DEVICE MONITORING – IN PERSON continued | |||
93289 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements | $35* | $70 |
93287 | Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system | $21* | $51 |
ICD/CRT-D DEVICE MONITORING – REMOTE | |||
93295 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional | $35 | $35 |
93296 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | NA | $21 |
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – IN PERSON | |||
93290 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors | $20* | $52 |
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – REMOTE | |||
93297 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional | NA | $59 |
G2066 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | Carrier priced | Carrier priced |
ICM DEVICE MONITORING – IN PERSON | |||
93285 | Programming device evaluation, (in person) with iterative adjustment of the implantable device to test function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm monitor system | $24* | $59 |
93291 | Interrogation device evaluation, (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; including heart rhythm derived data analysis, subcutaneous cardiac rhythm monitor system, including heart rhythm derived data | $17* | $48 |
PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
93298 | Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of heart rhythm derived data, analysis review(s) and report(s) by a physician or other qualified health care professional | NA | $100 |
PHYSICIAN REIMBURSEMENT FOR IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
IMPLANT | |||
33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | $84 | $4,071 |
REMOVAL | |||
33286 | Removal, subcutaneous cardiac rhythm monitor | $82 | $127 |
PHYSICIAN REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
SYSTEM IMPLANT OR REPLACEMENT | |||
33249 | Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber | $879 | NA |
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT) | |||
33262 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system | $360 | NA |
33263 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system | $374 | NA |
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT) | |||
33241 | Removal of implantable defibrillator pulse generator only | $209 | NA |
GENERATOR IMPLANT | |||
33240 | Insertion of implantable defibrillator pulse generator only; with existing single lead | $356 | NA |
33230 | Insertion of implantable defibrillator pulse generator only; with existing dual leads | $362 | NA |
RELOCATION OF SKIN POCKET | |||
33223 | Relocation of skin pocket for implantable defibrillator | $396 | NA |
LEAD PROCEDURES | |||
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | $359 | NA |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | $357 | NA |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | $300 | NA |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator | $377 | NA |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator | $369 | NA |
33244 | Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction | $833 | NA |
PHYSICIAN REIMBURSEMENT FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT)
CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Add-on codes qualify for separate payment for physicians and are not subject to the Physician Multiple Payment Reduction Rule.
CPT‡ CODE | ADD-ON CODE CPT‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE) | MEDICARE RATE | REPORT WITH PRIMARY PROCEDURE CODE | |
2024 FACILITY |
2024 NON-FACILITY |
|||
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES | ||||
+33225 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure) | $442 | NA | 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33221, 33223, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33240, 33249, 33263, or 33264 |
PHYSICIAN ADDITIONAL CODES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
OTHER CRT PROCEDURES | |||
33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) | $419 | NA |
33226 | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) | $405 | NA |
33229 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system | $360 | NA |
33221 | Insertion of pacemaker pulse generator only; with existing multiple leads | $346 | NA |
33264 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system | $390 | NA |
33231 | Insertion of implantable defibrillator pulse generator only; with existing multiple leads | $388 | NA |
ASC REIMBURSEMENT FOR PACEMAKERS
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
SYSTEM IMPLANT OR REPLACEMENT | ||
33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | $7,223 |
33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | $7,421 |
33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | $7,639 |
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT) | ||
33227 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system | $6,297 |
33228 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system | $7,465 |
SYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER | ||
33214 | Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) | $7,663 |
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT) | ||
33233 | Removal of permanent pacemaker pulse generator only | $5,580 |
GENERATOR IMPLANT | ||
33212 | Insertion of pacemaker pulse generator only; with existing single lead | $6,316 |
33213 | Insertion of pacemaker pulse generator only; with existing dual leads | $7,588 |
RELOCATION OF SKIN POCKET | ||
33222 | Relocation of skin pocket for pacemaker | $946 |
LEAD PROCEDURES | ||
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | $5,643 |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | $5,430 |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | $1,548 |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator | $2,037 |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator | $2,662 |
33234 | Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular | $2,690 |
33235 | Removal of transvenous pacemaker electrode(s); dual lead system | $2,037 |
ASC REIMBURSEMENT FOR CARDIAC DEVICE MONITORING
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
PACEMAKER/CRT-P DEVICE MONITORING – IN PERSON | ||
93279 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber | NA |
93280 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system | NA |
93281 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system | NA |
93288 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encoun- ter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system | NA |
93286 | Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system | NA |
93293 | Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days | NA |
PACEMAKER/CRT-P DEVICE MONITORING – REMOTE | ||
93294 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional | NA |
93296 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | NA |
ICD/CRT-D DEVICE MONITORING – IN PERSON | ||
93282 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system | NA |
93283 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system | NA |
93284 | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system | NA |
93289 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements | NA |
93287 | Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system | NA |
ASC REIMBURSEMENT FOR CARDIAC DEVICE MONITORING
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
ICD/CRT-D DEVICE MONITORING – REMOTE | ||
93295 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional | NA |
93296 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | NA |
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – IN PERSON | ||
93290 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors | NA |
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – REMOTE | ||
93297 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional | NA |
G2066 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | NA |
ICM DEVICE MONITORING – IN PERSON | ||
93285 | Programming device evaluation, (in person) with iterative adjustment of the implantable device to test function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm monitor system | NA |
93291 | Interrogation device evaluation, (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; including heart rhythm derived data analysis, subcutaneous cardiac rhythm monitor system, including heart rhythm derived data | NA |
ICM DEVICE MONITORING – REMOTE | ||
93298 | Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of heart rhythm derived data, analysis review(s) and report(s) by a physician or other qualified health care professional | NA |
ASC REIMBURSEMENT FOR IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
IMPLANT | ||
33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | $6,904 |
REMOVAL | ||
33286 | Removal, subcutaneous cardiac rhythm monitor | $365 |
ASC REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
SYSTEM IMPLANT OR REPLACEMENT | ||
33249 | Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber | $24,843 |
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT) | ||
33262 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system | $19,146 |
33263 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system | $19,129 |
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT) | ||
33241 | Removal of implantable defibrillator pulse generator only | $2,037 |
GENERATOR IMPLANT | ||
33240 | Insertion of implantable defibrillator pulse generator only; with existing single lead | $19,843 |
33230 | Insertion of implantable defibrillator pulse generator only; with existing dual leads | $19,039 |
RELOCATION OF SKIN POCKET | ||
33223 | Relocation of skin pocket for implantable defibrillator | $946 |
LEAD PROCEDURES | ||
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | $5,643 |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | $5,430 |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | $1,548 |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator | $2,037 |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator | $2,662 |
ASC REIMBURSEMENT FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT)
CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Medicare does not make separate payment for add-on code 33225 in the ASC setting.
CPT‡ CODE | ADD-ON CODE CPT‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE) | REPORT WITH PRIMARY PROCEDURE CODE | MEDICARE RATE ASC |
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES | |||
Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) ” (List separately in addition to code for primary procedure) +33225 |
33206 | $7,223 | |
33207 | $7,421 | ||
33208 | $7,639 | ||
33212 | $6,316 | ||
33213 | $7,588 | ||
33214 | $7,663 | ||
33216 | $5,643 | ||
33217 | $5,430 | ||
33221 | $13,052 | ||
33223 | $946 | ||
33228 | $7,466 | ||
33229 | $12,867 | ||
33230 | $19,039 | ||
33231 | $25,183 | ||
33233 | $5,580 | ||
33234 | $2,690 | ||
33235 | $2,037 | ||
33240 | $19,843 | ||
33249 | $24,843 | ||
33263 | $19,129 | ||
33264 | $25,027 |
ASC ADDITIONAL CODES
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
OTHER CRT PROCEDURES | ||
33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) | $7,724 |
33226 | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) | $1,950 |
33229 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system | $12,867 |
33221 | Insertion of pacemaker pulse generator only; with existing multiple leads | $13,052 |
33264 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system | $25,027 |
33231 | Insertion of implantable defibrillator pulse generator only; with existing multiple leads | $25,183 |
+ Indicates an add-on-code. List add-on-code(s) separately in addition to the primary procedure performed.
NEUROMODULATION
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
TRIAL PROCEDURE | |||
63650 | Percutaneous implantation of neurostimulator electrode array, epidural | $407 | $2,236 |
PERMANENT PROCEDURES | |||
63650 | Percutaneous implantation of neurostimulator electrode array, epidural | $407 | $2,236 |
63655 | Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural | $838 | NA |
63685 | Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver | $337 | NA |
REVISION AND REMOVAL PROCEDURES | |||
63661 | Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy when performed | $326 | $675 |
63662 | Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed | $851 | NA |
63663 | Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed | $444 | $889 |
63664 | Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) via laminotomy or laminectomy, including fluoroscopy, when performed | $886 | NA |
63688 | Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array | $298 | NA |
ELECTRONIC ANALYSIS AND DEVICE PROGRAMMING | |||
95970* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming | $18 | $18 |
95971* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional | $38 | $47 |
95972* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional | $39 | $56 |
* A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer’s representative, analysis and programming of a patient’s medical product or device “incident to” the physician’s other services performed in the office setting. A patient or his payer should not be billed for analysis and programming services performed at the direction of the physician by a manufacturer’s representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
NA: There is no Medicare valuations for these codes and these procedures are not typically performed in an in-office setting.
PHYSICIAN REIMBURSEMENT FOR RADIOFREQUENCY ABLATION (RFA)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
CERVICAL SPINE/THORACIC SPINE | |||
64633 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint | $188 | $430 |
64634 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint | $65 | $251 |
LUMBAR SPINE/SACRAL SPINE | |||
64635 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint | $188 | $434 |
64636 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint | $57 | $236 |
GENICULAR NERVE | |||
64624 | Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed | $143 | $382 |
SACROILIAC JOINT | |||
64625 | Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography) | $191 | $465 |
OTHER PERIPHERAL NERVES | |||
*64640 | Destruction by neurolytic agent; other peripheral nerve or branch | $117 | $244 |
77002 | Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) | NA | $114 |
UNLISTED PROCEDURE | |||
64999 | Unlisted procedure, nervous system | NA | Carrier priced |
PHYSICIAN REIMBURSEMENT FOR DEEP BRAIN STIMULATION (DBS)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
DIAGNOSTIC SERVICES | |||
70450-26 | Computed tomography, head or brain; without contrast material | $39 | $39 |
70551-26 | Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material | $68 | $68 |
76376-26 | 3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image post processing under concurrent supervision; not requiring image post processing on an independent workstation | $9 | $9 |
76377-26 | 3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image post processing under concurrent supervision; requiring image post processing on an independent workstation | $37 | $37 |
LEAD PROCEDURES | |||
61863 | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array | $1,506 | NA |
61864 | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) | $278 | NA |
61867 | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array | $2,272 | NA |
61868 | Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure) | $491 | NA |
61880 | Revision or removal of intracranial neurostimulator electrodes | $591 | NA |
INTRAOPERATIVE STIMULATION WITH MICROELECTRODE RECORDING | |||
95961-26 | Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional | $156 | $156 |
95962-26 | Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (List separately in addition to code for primary procedure) | $166 | $166 |
NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. Modifier 26 signifies the professional component of the hospital-based services
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE | |
2024 FACILITY |
2024 NON-FACILITY |
||
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES | |||
61885 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array | $530 | NA |
61886 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays | $885 | NA |
61888 | Revision or removal of cranial neurostimulator pulse generator or receiver | $398 | NA |
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING* | |||
95970* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming | $18 | $18 |
95983* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/ transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional | $48 | $49 |
95984 | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/ transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure) | $42 | $43 |
ASC REIMBURSEMENT FOR SPINAL CORD STIMULATION (SCS)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
TRIAL PROCEDURE | ||
63650 | Percutaneous implantation of neurostimulator electrode array, epidural | $4,952 |
PERMANENT PROCEDURES | ||
63650 | Percutaneous implantation of neurostimulator electrode array, epidural | $4,952 |
63655 | Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural | $17,993 |
63685 | Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver | $25,298 |
REVISION AND REMOVAL PROCEDURES | ||
63661 | Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy when performed | $898 |
63662 | Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed | $1,898 |
63663 | Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed | $4,864 |
63664 | Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) via laminotomy or laminectomy, including fluoroscopy, when performed | $10,317 |
63688 | Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array | $1,898 |
ELECTRONIC ANALYSIS AND DEVICE PROGRAMMING | ||
95970* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming | NA |
95971* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming | NA |
95972* | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional | NA |
”NA” expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any, modifiers should be used first.
ASC REIMBURSEMENT FOR RADIOFREQUENCY ABLATION (RFA)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
CERVICAL SPINE/THORACIC SPINE | ||
64633 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint | $898 |
64634 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint | NA |
LUMBAR SPINE/SACRAL SPINE | ||
64635 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint | $898 |
64636 | Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint | NA |
GENICULAR NERVE | ||
64624 | Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed | $898 |
SACROILIAC JOINT | ||
64625 | Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) | $898 |
OTHER PERIPHERAL NERVES | ||
*64640 | Destruction by neurolytic agent; other peripheral nerve or branch | $173 |
77002 | Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) | NA |
UNLISTED PROCEDURE | ||
64999 | Unlisted procedure, nervous system | NA |
ASC REIMBURSEMENT FOR DEEP BRAIN STIMULATION (DBS)
CPT‡ CODE | CPT‡ CODE DESCRIPTION | MEDICARE RATE ASC |
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES | ||
61885 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array | $19,380 |
61886 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays | $25,340 |
61888 | Revision or removal of cranial neurostimulator pulse generator or receiver | $10,782 |
IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING* | ||
61880 | Revision or removal of intracranial neurostimulator electrodes | $1,898 |
*CPT‡ code 64640 may not be billed more than 5 times on a single date of service.
”NA” expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
SUMMARY
DISCLAIMER
This material and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently and is subject to change without notice. The customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.
The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. It is the responsibility of the hospital or physician to determine appropriate coding for a particular patient and/ or procedure. Any claim should be coded appropriately and supported with adequate documentation in the medical record. A determination of medical necessity is a prerequisite that Abbott assumes will have been made prior to assigning codes or requesting payments. Any codes provided are examples of codes that specify some procedures, or which are otherwise supported by prevailing coding practices. They are not necessarily correct coding for any specific procedure using Abbott’s products.
Hospitals and physicians should consult with appropriate payers, including Medicare Administrative Contractors, for specific information on proper coding, billing, and payment levels for healthcare procedures. Abbott makes no express or implied warranty or guarantee that (i) the list of codes and narratives in this document is complete or error-free, (ii) the use of this information will prevent difference of opinions or disputes with payers, (iii) these codes will be covered [or (iv) the provider will receive the reimbursement amounts set forth herein]. Reimbursement policies can vary considerably from one region to another and may change over time.
The FDA-approved/cleared labeling for all products may not be consistent with all uses described herein. This document is in no way intended to promote the off-label use of medical devices. The content is not intended to instruct hospitals and/or physicians on how to use medical devices or bill for healthcare procedures.
- Physician Prospective Payment-Final rule with Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY2024. CMS-1784-F: https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfsfederal-regulation-notices/cms-1784-f
- Ambulatory Surgical Center Payment-Notice of Final Rulemaking with Comment Period(NFRM) CY2024. CMS-1786cms-FC: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1786-fc
Information contained herein for DISTRIBUTION in the US ONLY.
CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at vascular.eifu.abbott or at medical.abbott/manuals for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events. This material is intended for use with healthcare professionals only.
Abbott
One St. Jude Medical Dr., St. Paul, MN 55117, USA, Tel: 1 651 756 2000
3200 Lakeside Dr, Santa Clara, CA 95054 USA, Tel: 1 800 227 9902
™ Indicates a trademark of the Abbott group of companies.
‡ Indicates a third party trademark, which is property of its respective owner.
www.cardiovascular.abbott
www.neuromdulation.abbott
©2023 Abbott. All rights reserved. MAT-2000712 v10.0. Item approved for U.S. use only.
HE&R approved for non-promotional use only.
EFFECTIVE DATES: JANUARY 1, 2024 – DECEMBER 31, 2024
REFERENCES
Documents / Resources
Abbott Ambulatory Surgical Center ASC and Office Based Lab OBL Reimbursement Guide [pdf] User Manual Ambulatory Surgical Center ASC and Office Based Lab OBL Reimbursement Guide, Ambulatory Surgical, Center ASC and Office Based Lab OBL Reimbursement Guide, Based Lab OBL Reimbursement Guide, Lab OBL Reimbursement Guide, OBL Reimbursement Guide, Reimbursement Guide |