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Health Economics and Reimbursement Summary of PROPOSED 2015
Medicare Hospital Outpatient, Ambulatory Surgical Center and Physician
Payment Rates
Interventional Cardiology
Peripheral Interventions
Rhythm Management
On July 3, 2014, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY)2015 proposed
policies and payment rates for Medicare’s Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical
Centers (ASC). CMS also released the CY 2015 proposed rule and payment rates for the Physician Fee Schedule
(PFS). As is customary, CMS provides the public the ability to comment on proposed changes prior to finalizing their
decisions in the Final Rules. The final policy and payment rate are expected about November 1, 2014, and are effective
on January 1, 2015.
Hospital Outpatient: Average rates for outpatient services would increase by 2.1% in 2015 for more than 4,000
hospitals that participate in Medicare.
Ambulatory Surgical Center: Overall ASC payments are proposed to increase is 1.2%, over CY 2014 rates.
Approximately 5,300 ASC’s participate in Medicare and are paid under the ASC payment system.
Physician Fee Schedule: As a result of the recent Sustainable Growth Rate (SGR) patch passed earlier this year, the
current conversion factor of $35.8228 is effective through March 31, 2015. The proposed rates reflected in the Physician
Tables reflect the current conversion factor. In the proposed Physician Rule, CMS is mandated by law to control
spending by reducing the conversion factor by 20.9% effective on April 1, 2015 if Congress does not provide a short term
fix to minimize the SGR.
Proposed Changes Affecting Broader Medicare Policies
Comprehensive APCs - Based on the recommendation in last year’s Final Rule, CMS is proposing to move forward with
the implementation of Comprehensive APCs. Comprehensive APCs combine a number of procedures required to
support the delivery of the primary service into a single all-inclusive payment. Based on their proposal, CMS is making
modifications to restructure all device-dependent APCs into 28 comprehensive APCs (c-APCs). To ensure appropriate
accounting of all resources, CMS is proposing to apply complexity criteria for multiple procedure combinations designed
as c-APCs performed on the same date of service to allow for mapping to a higher APC within that clinical family of
procedures. In addition, they propose to package add-on codes performed with primary service assigned to the c-APC.
According to the Agency, the policy is being pursued to improve the accuracy and transparency of their payment for
certain device-dependent services. “Comprehensive APCs” result in a single all-inclusive payment for the primary
service with no additional reimbursement for concomitant procedures performed during the same operative session.
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Change to Inpatient Admission Documentation or Certification - While CMS did not change the two-midnight stay
requirement for inpatient admissions, the requirements for physician certification of inpatient admissions is proposed
to be revised which should be less burdensome to both hospitals and physicians. Under this proposal, physicians would
only need to certify for long-stay cases over twenty days and costly outlier cases. CMS believes that in most cases, the
Business
admission order, medical record and notes contain sufficient information to support the medical necessity
of anUnit Name
inpatient admission.
Hospital Outpatient Quality Reporting (OQR) Program - The Hospital Outpatient Quality Reporting Program (Hospital
OQR) is a pay for quality data reporting program implemented for outpatient hospital services. Under the Hospital OQR
Program, hospitals must meet administrative, data collection and submission, validation, and publication requirements
or receive a two percentage point reduction in their annual payment update (APU). CMS is proposing to remove three
measures, including one cardiac care measure, OQR-4: Aspirin at Arrival, as well as two prophylactic antibiotic surgery
measures as performance is high with little variation between hospitals. CMS also is proposing modifications to the
Hospital OQR Program validation process and formalization of a review and corrections period.
Implementation of Physician Value-Based Modifier - CMS continues to implement the value-based modifier for
physicians as required by the Affordable Care Act. This modifier is similar in concept to the value-based purchasing
program for hospitals. In their proposal, CMS is extending the program to solo practitioners and to physicians in groups
of two or more eligible professionals for participating in the Physician Quality Reporting System (PQRS). The 2017 valuebased modifier is based on 2015 performance. CMS also proposes to increase the maximum amount of payment risk
under the program from 2% in 2016 to 4% in 2017.
Valuation and Coding of the Global Surgical Package for Physician Payments - Physician payments for surgical
procedures also include payment for services before and after the surgery. CMS believes payment rates for many of
these surgical codes may be overinflated because they have not been updated in many years. As a result, CMS is
proposing over time to remove the costs of services performed before and after the surgery from the surgical procedure
payment rate and have providers bill individually for those services. We will be conducting analyses and reaching out to
physician societies to better understand the impact over the next few weeks.
Open Payments – Physician Sunshine Act Proposed Changes - CMS proposes a policy change in the “Sunshine Act” by
eliminating one exclusion for continuing medical education (CME) from physician disclosure. Currently payments
provided as compensation for speaking at a CME program do not have to be reported if (1) the event is accredited by
one of several organizations listed by CMS; (2) the manufacturer is not paying the covered recipient directly; and (3) if
the manufacturer does not select the recipient speaker or provide a list of identifiable individuals to be considered as
speakers. In response to comments, CMS is proposing to eliminate this exclusion. However, CMS will still retain
exclusion under their indirect payment provisions and consider payment to be excluded from reporting if the
manufacturer provides funding to a CME provider but does not select nor pay the covered recipient directly nor provide
the CME provider with a list of identifiable covered recipients to be considered as speakers.
Physician Quality Reporting System (PQRS) - Beginning in 2015, a downward payment adjustment will apply to eligible
professionals who do not satisfactorily report data on quality measures for covered professional services or
satisfactorily participate in a Qualified Clinical Data Registry (QCDR). In the CY2015, CMS has proposed to add 28 new
individual measures and two measures groups to fill existing measure gaps, as well as remove 73 measures from
reporting for the PQRS. These proposed changes would bring the PQRS individual measure set to 240 total measures.
While some additions are not cardiovascular specific, other measures may apply. For example, one measure entitled
“Closing the Referral Loop” will track the receipt of a Specialist (i.e. cardiologist or EP) Report for the percentage of
patients with referrals. The percentage will be how often the referring provider receives a report from the Specialist
provider to whom the patient was referred. Another possible measure is “Controlling High Blood Pressure” where the
percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was
adequately controlled (<140/90 mmHg) during the measurement period.
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CMS is proposing to make 2015 QCDR measure data available on Physician Compare, collected at the individual level or
aggregated to a higher level of the QCDR’s choosing – such as the group practice level.
Business Unit Name
Table Index
At the end of the document the following three tables list detailed changes for select Interventional Cardiology (IC),
Peripheral Intervention (PI), and Rhythm Management (RM), (reflective of Cardiac Rhythm Management and
Electrophysiology) device related procedures:
Table 1: Hospital Outpatient CY2015 Proposed Payment Rates
Table 2: ASC CY2015 Proposed Payment Rates
Table 3: Physician CY2015 Proposed Fee Schedule (Proposed rates calculated with current conversion factor of
$35.8228 and do not reflect proposed 20.9% SGR reduction.)
Highlights for Interventional Cardiology (IC), Peripheral Interventions (PI) and Rhythm Management (RM), are as follows:
Hospital Outpatient Payments (See Table 1 for Details)
Significant HOPPS/ASC Rule Proposals affecting many cardiovascular procedures
Packaged services - Seven new categories of items and services are proposed for packaging into the APC procedure
payment, including drugs and biologicals, diagnostics and laboratory tests, ancillary services, add-on codes, and device
removal procedures. These will be bundled with the primary procedure payment and will no longer be separately paid.
Comprehensive APCs – As highlighted earlier, CMS is proposing to replace all device-dependent APC’s with 28 new
comprehensive APCs which include the primary service and all adjunct services provided to support the delivery of the
primary service.
Impact to Payments - CMS has increased payment on many APCs as a result of the packaging and composite APC
proposals to reflect the increase in overall costs and elimination of separate payment for multiple procedures,
additional vessels procedures and other services indicated above. CMS is proposing to pay only for the main/primary
procedure or initial service code on a claim. A new status indicator “J1” will assigned to the packaged CPT codes.
For cardiovascular-specific procedures, the non-weighted average outpatient proposed payment rates from Table 1
are:



Interventional Cardiology increase by 49%.
Peripheral Intervention increase by 2%
Rhythm Management increase by 10%
Interventional Cardiology
Proposed comprehensive APCs will positively affect the level of reimbursement for Percutaneous Coronary Intervention
(PCI) procedures.
• Drug-eluting stent procedures with atherectomy, CTO, AMI, or BMS with atherectomy have proposed payment rate of
$14,759. This compares to a range of CY2014 rates for these procedures of $6,364 to $7,714.
• Drug-eluting stent with PTCA, bare metal stent procedures, or atherectomy without stent proposed payment rate of
$9,549 compared to a range of $6,364 to $8,843.
• When DES is part of CTO, AMI, atherectomy, or most second main coronary vessel procedures, the procedures will
group to the higher paying APC 0319 as a ‘Complexity Adjusted APC.’
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Peripheral Intervention
 PTA-only procedures proposed to decrease 2% to $4,334.
 Stent with/without PTA procedures proposed to increase 5% to $9,549.
 Combined PTA, Stent and atherectomy procedures proposed to decrease 5% to $14,759.
Business Unit Name
 Embolization proposed to increase 8% to $9,549 which reflects a change from APC 0082 to 0229.
Rhythm Management
Proposed comprehensive APCs for Rhythm Management procedures would result in several substantial
reimbursement increases, in particular for CRT and ablation procedures.






CMS proposed to reassign the S-ICD system implant procedure from APC 0107 (ICD pulse generator only) to APC
0108 (ICD/CRT-D system implants). The resulting year-over- year hospital proposed payment increase is ~ $5,627
or 22.5% for 2015. This change would fully map all facility S-ICD procedures to the same payment categories as
transvenous ICDs procedures.
As a result of the severity adjusted comprehensive APCs, the CRT-D replacement (APC assignment change from 0107
to 0108) would increase by 22.5% and CRT-P system implant procedures would increase by 56%.
Comprehensive EP studies in conjunction with ablation procedures would increase by 8%.
Single chamber pacemaker implants would increase 7.8%; dual chamber pacemaker implants would decrease by
10%.
Dual and single ICD implants would decrease by 4.7%
WATCHMAN™ Left Atrial Appendage Closure procedure (0281T) is restricted to the inpatient hospital site of service.
Ambulatory Surgical Center (See Table 2 for Detail)
Peripheral Interventions
 All lower extremity bundled PTA, stent and atherectomy procedures are allowed in the ASC; however, less than 1%
of PI procedures performed within the ASC.
Rhythm Management
ASC payments generally are down with the exception of S-ICD system implants. While most RM procedures are
allowed in the ASC setting, less than 1% are actually performed in ASCs.
 S-ICD payments would increase by 18% to ~$27,000.
 CRT-D system implant proposed to decrease by 8.7%.
 ICD system implants proposed to decrease by 8.7%, ICD PG only payment rates proposed to decrease by 10.8%.
 Dual chamber pacemaker system implant payment rates proposed to decrease by 16%, while dual chamber
pacemaker PG only payment rates proposed to increase by 7.5%
Physician Payments (See Table 3 for Details)
Please note that the payment rates listed in this document do not include the approximately 20.9% reduction in rates
which would be required by the Sustainable Growth Rate. In addition, the calculations have been made using the
CY2014 conversion factor of $35.8228 currently effective through March 31, 2015. The expectation is that Congress will
continue to do short term “fixes” to minimize the Sustainable Growth Rate (SGR).
Physician Fee Schedule Information (Table 3 Non-Weighted Average)
The overall average change for select procedures is as follows:
In-Facility
In-Office
Interventional Cardiology increase
0.3%
N/A
Peripheral Interventions
no change
-1%
Rhythm Management increase
0.9%
N/A
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Interventional Cardiology
Coronary Stenting
 DES & BMS stent payment proposed to increase by 0.3% to $625.
Business Unit Name
 CTO and DES/BMS stent with atherectomy proposed to increase 0.2% and 0.3% respectively to $700.
 AMI PCI proposed to increase 0.3% to $701.

Structural Heart-Valves
TAVR range of codes stable, up slightly 0.1%.
Peripheral Interventions
CPT Code Evaluation - CMS has specifically cited Thrombectomy CPT 36870 as potentially being mis-valued. The Agency
welcomes stakeholder input on what the reimbursement value of this procedure should be in the future (FY 2016).
Physician In-Facility reimbursement is proposed to remain relatively flat. Reimbursement of physicians for procedures
done in their office is proposed to decrease 1%.
 Atherectomy payments increase 1.4% to $12,751.
 HAM payments decrease 1.3% to $1,520.
 Embolization payments increase 0.8% to $7,354.
 Thrombectomy payments decrease 0.1% to $1,865.
Rhythm Management
Physician Quality Report System (PQRS) - Additional proposed PQRS reporting measures for 2015 have been added
which are applicable to Rhythm Management including Cardiac Tamponade and/or Pericardiocentesis following Atrial
Fibrillation Ablation and Infection within 180 days of Cardiac Implantable Electronic Device (CIED) Implantation,
Replacement, or Revision.
 Payment rates for device implants would remain relatively flat at a 0.81% increase.
 Ablation and mapping procedures would remain relatively flat at a 0.91% increase.
Comments or Questions
If you have questions or would like additional information please contact:
Interventional Cardiology (IC)/Peripheral Interventions (PI)
Tom Meskan – IC and PI
763-494-2016
[email protected]
Deb Lorenz – IC
763-494-2112
[email protected]
Brent Hale - PI
763-494-1448
[email protected]
Rhythm Management (RM)
Call 1-800-CARDIAC (request reimbursement support)
[email protected]
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Page 5 of 26
1
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American
Business Unit Name
Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units,
conversion factors, and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not
recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The
AMA assumes no liability for data contained or not contained herein.
2
Please note: this coding information may include some codes for procedures for which Boston Scientific currently
offers no cleared or approved products. In those instances, such codes have been included solely in the interest of
providing users with comprehensive coding information and are not intended to promote the use of any Boston
Scientific products for which they are not cleared or approved.
Note: Some of the codes presented above may be used to code for a variety of procedures (diagnostic and therapeutic)
employed in the field of electrophysiology, including atrial fibrillation, atrial flutter, AV Node, SVT and VT
ablations. Please note that no Boston Scientific products are approved for sale in the US for ablation for atrial
fibrillation.
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Page 6 of 26
Table 1: CY2015 Hospital Outpatient Proposed Payment Rates for Select Procedures
APC
Descriptor
Interventional Cardiology
Diagnostic Cardiac Catheterization
0080
Coronary or Non‐Coronary Atherectomy
0082
Level I Endovascular Procedures
*
0083
0104
0229
*
0229
0319
Transcatheter Placement of Intracoronary Stents
Level II Endovascular Procedures (Atherectomy, BMS, BMS AMI, BMS CTO, BMS Bypass Graft; Previous APC 104)
Level II Endovascular Procedures (DES w/PTCA and DES Bypass Graft; Previous APC 656)
Level III Endovascular Procedures (BMS w Atherectomy; Previous APC 104)
Level III Endovascular Procedures (DES w Atherectomy, DES CTO, or DES AMI; Previous APC 656)
Transcatheter Placement of Intracoronary Drug‐Eluting 0656
Stents
Peripheral Interventions
0082
Coronary or Non‐Coronary Atherectomy
Level I Endovascular Procedures (PTA)
*
0083
Thrombectomy
0088
Vascular Reconstruction/Fistula Repair
0093
Level I Percutaneous Abdominal and Biliary Procedures 0152
(Biliary Stenting)
Level II Cystourethroscopy and other Genitourinary 0161
Procedures
Level II Endovascular Procedures (PTA & Stent, *
0229
Embolization)
Level IV Endovascular Procedures (PTA, Stent & *
0319
Atherectomy)
Level II Endoscopy Lower Airway
0415
Level II Tube Changes and Repositioning
0427
0319
0652
Insertion of Intraperitoneal and Pleural Catheters
Level I Angiography and Venography
0668
Thrombolysis and Other Device Revisions 0676
Brachytherapy, non‐str,Yttrium‐90
2616
Rhythm Management
Level III Pacemaker and Similar Procedures (PM system, 0089
Previous APC 0655)
Level II Pacemaker and Similar Procedures (PM 0090
replacement or lead only)
0655
Pacemaker – Dual Chamber System
S‐ICD Implant ‐ Level II ICD and Similar Procedures 0108
(Previous APC 0107)
0108
0107
0080
Level II ICD and Similar Procedures (ICD or CRTD System
or CRT-D Replacement)
Level I ICD and Similar Procedures (ICD/S‐ICD PG only, Previous APC 0107)
Diagnostic Cardiac Catheterization
CY2015 Variance 2015 CY2014 Final Proposed Proposed vs. 2014 Rate
Rate
Final
$2,600
$4,334
$2,587
$13
Proposed to be deleted in CY2015
$4,410
‐$76
% YoY Change
0.51%
‐1.73%
Proposed to be deleted in CY2015
$9,549
$6,364
$3,185
50.04%
$9,549
$7,714
$1,835
23.78%
$14,759
$6,364
$8,395
131.91%
$14,759
$7,714
$7,045
91.33%
Proposed to be deleted in CY2015
$4,334
$3,281
$2,443
Proposed to be deleted in CY2015
$4,410
‐$76
$3,272
$9
$2,847
‐$404
‐1.73%
0.29%
‐14.18%
$1,832
$1,788
$44
2.45%
$1,235
$1,205
$30
2.51%
$9,549
$9,120
$429
4.70%
$14,759
$15,510
‐$751
‐4.84%
$2,261
$1,454
$2,000
$1,306
$261
$148
13.05%
11.30%
$2,641
$2,417
$224
9.26%
$843
$200
$16,017
$827
$184
$16,829
$16
$16
‐$812
1.95%
8.75%
‐4.82%
$9,478
$10,588
‐$1,110
‐10.48%
$6,649
NA
NA
NA
$16,536
$10,588
$5,947
56.17%
$30,645
$25,018
$5,627
22.49%
$30,645
$32,145
‐$1,500
‐4.66%
$23,083
$25,018
‐$1,935
‐7.74%
$2,600
$2,587
$13
0.51%
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7
Table 1: CY2015 Hospital Outpatient Proposed Payment Rates for Select Procedures
APC
CY2015 Variance 2015 CY2014 Final Proposed Proposed vs. 2014 Rate
Rate
Final
Descriptor
% YoY Change
0084
0085
Level I EP Procedures
Level II EP Procedures
$881
$4,592
$754
$4,233
$127
$359
16.85%
8.48%
0086
Level III Electrophysiologic Procedures (EP study +
Ablation, Previous APC 8000)
$14,169
$13,115
$1,054
8.04%
* Symbol notes comprehensive APC
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8
Table 2: Ambulatory Surgical Center (ASC)
ASC CY2015 Proposed Payment Rates for Select Procedures
CY2015 CY2014 Final Variance 2015 Proposed Proposed Abbreviated (Partial) Description
vs. 2014 Final
Payment
Payment
$
$
$
%
CPT®
Peripheral Interventions
Hemodialysis PTA
35476
Transluminal balloon angioplasty, percutaneous; venous
Transluminal balloon angioplasty, percutaneous; brachiocephalic 35475
trunk or branches, each vessel
Iliac Revascularization *
37220
37221
Transluminal peripheral angioplasty, percutaneous; iliac
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
$1,243
$923
$319
34.57%
$1,318
$978
$339
34.69%
$2,069
$2,436
($367)
‐15.08%
$6,023
$5,038
$985
19.55%
$1,170
$1,703
($533)
‐31.29%
$1,776
$1,807
($31)
‐1.74%
$1,224
$1,105
$119
10.77%
$2,194
$2,268
($74)
‐3.28%
$992
$643
$643
$1,292
$669
$643
$988
$722
$722
$1,335
$666
$722
$4
($79)
($79)
($43)
$3
($79)
0.39%
‐10.89%
‐10.89%
‐3.24%
0.44%
‐10.89%
* Iliac procedures shown as sample: All 15 LE bundled codes (37220‐37235) are allowed in the ASC
Thrombectomy
Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra‐graft thrombolysis)
Thrombectomy, with or without catheter; axillary and subclavian 34490
vein, by arm incision
Trach Bronch Stent
Bronchosopy (rigid or flexible); with tracheal dilation and placement 31631
of tracheal stent
Biliary Stenting
Biliary endoscopy, percutaneous via T‐tube or other tract; with 47556
dilation of biliary duct stricture(s) with stent
Insert catheter, bile duct
47510
Change bile duct catheter
47525
Revise/reinsert bile tube
47530
Insert abdom drain, perm
49421
Insert kidney drain
50392
Exchange drainage catheter
49423
36870
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9
CPT®
Table 2: Ambulatory Surgical Center (ASC)
ASC CY2015 Proposed Payment Rates for Select Procedures
CY2015 CY2014 Final Variance 2015 Proposed Proposed Abbreviated (Partial) Description
vs. 2014 Final
Payment
Payment
$
$
$
%
Rhythm Management
Pacemaker ‐ dual chamber system implant
33208
Pacemaker ‐ dual chamber pulse generator only
33213
ICD system implant
33249
ICD pulse generator only
33240
S‐ICD System Implant
0319T
33249 +
33225
CRT-D System implant (33249 & 33225 when performed on the same
day)
$7,799
$7,799
$27,005
$20,400
$27,005
$9,286
$7,256
$29,600
$22,882
$22,882
($1,487)
$543
($2,595)
($2,481)
$4,123
‐16.01%
7.48%
‐8.77%
‐10.84%
18.02%
$29,600
$29,600
$0
0.00%
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10
Modifier
Table 3: Physician Fee Schedule CY2015 Proposed Rule Payment Rates
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed vs. Proposed In‐
CPT®
Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Interventional Cardiology
Diagnostic Catheterization
$149
($2)
‐1.42%
$149
($2)
‐1.42%
93451 26 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
NA
NA
NA
$793
$4
0.45%
93451
$262
($4)
‐1.35%
$262
($4)
‐1.35%
93452 26 Left heart catheterization including intraprocedural injection(s) for left ventriculography; imaging supervision and NA
NA
NA
$896
$9
1.05%
93452
$344
($4)
‐1.03%
$344
($4)
‐1.03%
93453 26 Combined right heart cath and left heart catheterization including intraprocedural injection(s) for left ventriculography, NA
NA
NA
$1,153
$5
0.41%
93453
$263
($4)
‐1.34%
$263
($4)
‐1.34%
93454 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$907
$3
0.36%
93454
$304
($4)
‐1.16%
$304
($4)
‐1.16%
93455 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,056
$4
0.37%
93455
$339
($3)
‐0.84%
$339
($3)
‐0.84%
93456 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,135
$3
0.28%
93456
$379
($4)
‐1.03%
$379
($4)
‐1.03%
93457 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,282
$3
0.20%
93457
$320
($5)
‐1.65%
$320
($5)
‐1.65%
93458 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,086
$3
0.23%
93458
$362
($5)
‐1.37%
$362
($5)
‐1.37%
93459 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,200
$4
0.30%
93459
$403
($5)
‐1.23%
$403
($5)
‐1.23%
93460 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary $5
0.39%
NA
NA
NA
$1,289
93460
$446
($5)
‐1.11%
$446
($5)
‐1.11%
93461 26 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary NA
NA
NA
$1,474
$6
0.39%
93461
93462
Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
$214
($0)
‐0.17%
$214
($0)
‐0.17%
93463
Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure)
$101
($8)
‐7.54%
$101
($8)
‐7.54%
Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and $89
NA
($9)
NA
‐9.45%
NA
$89
$278
($9)
($6)
‐9.45%
‐2.27%
93464
93464
26
93531
26
Combined right heart catheterization and retrograde left heart cath, for congenital cardiac anomalies
$451
($12)
‐2.63%
$451
($12)
‐2.63%
93532
26
Combined right heart catheterization and transseptal left heart cath through intact septum with or w/o retrograde left heart catheterization, for congenital cardiac anomalies
$559
$4
0.65%
$559
$4
0.65%
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
11
CPT®
Modifier
93533
26
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Combined right heart catheterization and transseptal left heart cath through existing septal opening, with or w/o retrograde left heart catheterization, for congenital cardiac anomalies
$374
$2
0.48%
$374
$2
0.48%
93565
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective left ventricular or left arterial angiography (List separately in addition to code for primary procedure)
$47
$3
5.65%
$47
$3
5.65%
93566
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure)
$48
$4
8.06%
$174
$1
0.62%
93567
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for supravalvular aotography (List separately in addition to code for primary procedure)
$54
$4
8.63%
$143
$1
0.50%
93568
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure)
$49
$4
7.94%
$155
$1
0.70%
$563
$2
0.32%
NA
NA
NA
$0
$0
NA
$0
$0
NA
$669
$1
0.21%
NA
NA
NA
$0
$0
NA
$0
$0
NA
$625
$2
0.34%
NA
NA
NA
Diagnostic Cath Injection
Angioplasty without Stent
Percutaneous transluminal coronary angioplasty; single major 92920
coronary artery or branch
92921
Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Atherectomy without Stent
Percutaneous transluminal coronary atherectomy, with 92924
coronary angioplasty when performed; single major coronary artery or branch
92925
Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Stent with Angioplasty
92928
Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
12
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
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) 92929
$0
$0
NA
$0
$0
NA
$700
$2
0.31%
NA
NA
NA
Stent with Atherectomy
92933
Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
92934
Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
$0
$0
NA
$0
$0
NA
92937
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
$625
$2
0.29%
NA
NA
NA
92938
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)
$0
$0
NA
$0
$0
NA
$701
$2
0.26%
NA
NA
NA
$700
$1
0.21%
NA
NA
NA
Bypass Graft
Acute Myocardial Infarction
92941
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
Chronic Total Occlusion
92943
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
13
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)
92944
$0
$0
NA
$0
$0
NA
Percutaneous transluminal coronary thrombectomy mechanical
$183
$1
0.39%
NA
NA
NA
26
Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List
separately in addition to code for primary procedure)
$100
$10
10.67%
$100
$10
10.67%
26
Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure)
$81
$8
10.29%
$81
$8
10.29%
26
Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure)
$100
$10
10.67%
$100
$10
10.67%
26
Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure)
$80
$7
9.27%
$80
$7
9.27%
$1,257
$1,299
($113)
($116)
‐8.26%
‐8.20%
NA
NA
NA
NA
NA
NA
$1,020
($93)
‐8.37%
NA
NA
NA
Thrombectomy
92973
IVUS
92978
92979
FFR
93571
93572
Valvuloplasty
92986
Percutaneous balloon valvuloplasty; aortic valve
92987
Percutaneous balloon valvuloplasty; mitral valve
92990
Percutaneous balloon valvuloplasty; pulmonary valve
Transcatheter Aortic Valve Replacement
33361
Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; percutaneous femoral artery approach
$1,406
$2
0.15%
NA
NA
NA
33362
Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open femoral artery approach
$1,536
$1
0.09%
NA
NA
NA
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
14
33363
33364
33365
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Transcatheter aortic valve replacement (tavr/tavi) with $1,615
$26
1.65%
NA
NA
NA
prosthetic valve; open axillary artery approach
Transcatheter aortic valve replacement (tavr/tavi) with $1,672
$0
0.02%
NA
NA
NA
prosthetic valve; open iliac artery approach
Transcatheter aortic valve replacement (tavr/tavi) with $1,841
($3)
‐0.14%
NA
NA
NA
prosthetic valve; transaortic approach (e.g., median sternotomy, mediastinotomy)
33366
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy)
$2,007
$12
0.61%
NA
NA
NA
33367
Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (list separately in addition to code for primary procedure)
$640
($4)
‐0.56%
NA
NA
NA
33368
Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure)
$775
($5)
‐0.64%
NA
NA
NA
33369
Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure)
$1,024
($5)
‐0.52%
NA
NA
NA
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
15
Modifier
Table 3: Physician Fee Schedule CY2015 Proposed Rule Payment Rates
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed vs. Proposed In‐
CPT®
Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Peripheral Interventions
Non‐Coronary Angioplasty
Transluminal balloon angioplasty, percutaneous; 35475
$349
($6)
‐1.81%
$1,588
($22) ‐1.36%
brachiocephalic trunk or branches, each vessel
35476
Transluminal balloon angioplasty, percutaneous; venous
Radiological S&I (Non‐Cor Angioplasty)
75962 26 Transluminal balloon angioplasty, peripheral artery other than cervical carotid, renal or other visceral artery, iliac or lower 75962
75964 26 Transluminal balloon angioplasty, each additional peripheral artery other than cervical carotid, renal or other visceral artery, 75964
75966 26 Transluminal balloon angioplasty, renal/visceral artery, radiological S&I
75966
75968 26 Transluminal balloon angioplasty, renal/visceral, each additional artery, S&I (List separately in addition to code for primary 75968
75978 26 Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological S&I
75978
Iliac Artery Revascularization
$282
($1)
‐0.38%
$1,452
($18)
‐1.19%
$27
NA
$18
NA
$65
NA
$18
NA
$27
NA
$0
NA
($0)
NA
$1
NA
$1
NA
$0
NA
0.00%
NA
‐1.96%
NA
2.25%
NA
4.08%
NA
0.00%
NA
$27
$140
$18
$87
$65
$172
$18
$89
$27
$138
$0
($8)
($0)
($8)
$1
($4)
$1
$0
$0
($8)
0.00%
‐5.11%
‐1.96%
‐7.95%
2.25%
‐2.04%
4.08%
0.40%
0.00%
‐5.42%
37220
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
$435
($1)
‐0.16%
$3,211
($24)
‐0.75%
37221
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
$534
$4
0.68%
$4,736
($14)
‐0.29%
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)
$196
$0
0.00%
$901
($10)
‐1.14%
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)
$225
$1
0.32%
$2,640
$2
0.07%
$479
($3)
‐0.60%
$3,896
($23)
‐0.59%
$648
($2)
‐0.28%
$11,210
$20
0.18%
Femoral/Popliteal Artery Revascularization
Revascularization, endovascular, open or percutaneous, 37224
femoral/popliteal artery(s), unilateral; with transluminal angioplasty
37225
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within same vessel, when performed
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
16
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
37226
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s),unilateral;with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$562
$29
5.38%
$9,218
$30
0.33%
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
$779
($3)
‐0.41%
$15,143
$79
0.52%
$5,542
($27)
‐0.48%
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
Tibeal / Peroneal Artery Revascularization
Revascularization, endovascular, open or percutaneous, $585
($2)
‐0.37%
37228
tibeal\peroneal artery, unilateral, initial vessel; with transluminal angioplasty
37229
Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
$756
($3)
‐0.42%
$11,062
$41
0.37%
37230
Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$746
$10
1.36%
$8,455
$21
0.25%
37231
Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
$810
$4
0.49%
$13,589
$126
0.93%
37232
Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code fore primary procedure)
$212
($1)
‐0.34%
$1,236
($2)
‐0.17%
37233
Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code fore primary procedure)
$345
($3)
‐0.82%
$1,496
$10
0.65%
1.09%
$3,951
$16
0.41%
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
37234
Revascularization, endovascular, open or percutaneous, tibeal\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 fore primary procedure)
$298
$3
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
17
37235
37236
37237
37238
37239
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Revascularization, endovascular, open or percutaneous, tibeal\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 fore primary procedure)
Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure)
Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure)
$411
($17)
‐3.94%
$4,249
$232
5.78%
$458
($24)
‐4.98%
$2,834
($29)
‐1.00%
$225
$0
0.00%
$1,234
($9)
‐0.75%
$333
($5)
‐1.48%
$4,182
($4)
‐0.09%
$167
$9
5.92%
$2,073
($8)
‐0.38%
Catheter Access
36140
Introduction of needle or intracatheter; extremity artery
$107
($0)
‐0.33%
$444
($1)
‐0.32%
36147
36148
Access av dial grft for eval
Access av dial grft for proc
$194
$51
($0)
$0
‐0.18%
0.70%
$850
$266
($3)
$1
‐0.34%
0.27%
36160
Introduction of needle or intracatheter, aortic, translumbar
$129
($4)
‐3.22%
$504
($16)
‐3.10%
$159
$0
0.23%
$634
($0)
‐0.06%
36200
Introduction of catheter, aorta
Catheter Placement
36215
Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family
$245
($7)
‐2.70%
$1,145
$25
2.21%
36216
Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family
$285
($3)
‐1.00%
$1,190
($73)
‐5.81%
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
18
36217
36218
36245
36246
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Selective catheter placement, arterial system; initial third order $337
($8)
‐2.39%
$1,924 ($249) ‐11.44%
or more selective thoracic or brachiocephalic branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
$55
$0
0.00%
$188
($15)
‐7.56%
$263
($4)
‐1.34%
$1,389
$5
0.34%
$280
$0
0.00%
$907
$0
0.04%
36247
Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
$331
($4)
‐1.07%
$1,603
($4)
‐0.27%
36248
Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate
$52
($2)
‐3.36%
$155
($1)
‐0.69%
Carotid Artery Stenting
37215
Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection
$1,135
$7
0.64%
NA
NA
NA
37216
Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; without distal embolic protection
$1,049
($1)
‐0.07%
NA
NA
NA
37191
Insertion of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed.
$249
($1)
‐0.29%
$2,676
($8)
‐0.28%
37192
Repositioning of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed.
$425
$48
12.75%
$1,738
$183
11.80%
37193
Retrieval (removal) of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed.
$382
($3)
‐0.84%
$1,630
($8)
‐0.48%
Vena Cava Filters
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
19
Modifier
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. CPT®
Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Thrombectomy
36870
Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra‐graft thrombolysis)
$313
($0)
‐0.11%
$1,865
($2)
‐0.10%
34101
Thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision
$632
($3)
‐0.51%
NA
NA
NA
$629
($6)
‐0.96%
NA
NA
NA
$1,085
($8)
‐0.75%
NA
NA
NA
$641
$1
0.22%
NA
NA
NA
Thrombectomy, with or without catheter; radial or ulnar artery, by arm incision
Thrombectomy, with or without catheter; femoral\popliteal, 34201
aortoiliac artery, by leg incision
Thrombectomy, with or without catheter; axillary and 34490
subclavian vein, by arm incision
Non‐Coronary IVUS
34111
37250
Intravascular ultrasound (non‐coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure)
$111
($1)
‐0.64%
NA
NA
NA
37251
Intravascular ultrasound (non‐coronary vessel) during diagnostic evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure)
$84
($0)
0.00%
NA
NA
NA
Radiological S&I (Non‐Cor IVUS)
75945
26
Intravascular ultrasound (peripheral vessel) radiological supervision and interpretation; initial vessel
$20
$0
1.79%
$20
$0
1.79%
75946
26
each additional non‐coronary vessel (List separately in addition to code for primary procedure)
$20
$0
0.00%
$20
$0
0.00%
0.65%
NA
1.66%
NA
1.26%
NA
$56
$162
$66
$188
$58
$151
$0
($15)
$1
($23)
$1
($14)
0.65%
‐8.32%
1.66%
‐11.02%
1.26%
‐8.68%
0.62%
NA
0.56%
NA
7.79%
NA
$58
$171
$65
$184
$59
$164
$0
($12)
$0
($21)
$4
($10)
0.62%
‐6.65%
0.56%
‐10.14%
7.79%
‐5.77%
0.15%
NA
NA
NA
Angiograms
75710 26 Angiography, extremity, unilateral, radiological supervision and $56
$0
interpretation
75710
NA
NA
75716 26 Angiography, extremity, bilateral, radiological supervision and $66
$1
interpretation
75716
NA
NA
75726 26 Angiography, visceral, selective or supraselective (with or $58
$1
without flush aortogram), radiological supervision and 75726
NA
NA
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
75731 26 Angiography, adrenal, unilateral, selective, radiological $58
$0
supervision and interpretation
75731
NA
NA
75733 26 Angiography, adrenal, bilateral, selective, radiological $65
$0
supervision and interpretation
75733
NA
NA
75736 26 Angiography, pelvic, selective or supraselective, radiological $59
$4
supervision and interpretation
75736
NA
NA
Bronchoscopy
31631
Bronchosopy; with placement of tracheal stent(s) (inludes tracheal/bronchial dilation as required)
$238
$0
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
20
Modifier
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. CPT®
Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Biliary Stenting
Biliary endoscopy, percutaneous via T‐Tube or other tract; with dilation of biliary duct stricture(s) with stent
$436
($1)
‐0.25%
NA
NA
NA
Radiological S&I (Biliary stenting)
Percutaneous transhepatic dilation of biliary duct stricture with 74363 26 or without placement of stent, radiological supervision and interpretation
Transhepatic Shunts (TIPS)
$45
($0)
‐0.79%
$45
($0)
‐0.79%
37182
Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein cath, portography with hemodynamic evaluation, intrahepatic tract formation/dilation, stent placement and all associated imaging and guidance and documentation)
$873
($2)
‐0.25%
NA
NA
NA
37183
Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS)(includes venous access, hepatic and portal vein cath, portography with hemodynamic evaluation, intrahepatic tract recanulization / dilation, stent placement and all associated imaging and guidance and documentation)
$411
($1)
‐0.17%
$6,001
$45
0.76%
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)
$462
($1)
‐0.31%
$4,667
$33
0.70%
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)
$516
($2)
‐0.35%
$7,867
$62
0.79%
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
$615
($2)
‐0.35%
$9,932
$78
0.80%
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
$718
($3)
‐0.35%
$6,950
$51
0.73%
47556
Embolization
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
21
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Drainage
47510
Introduction of percutaneous transhepatic catheter for biliary drainage Introduction of percutaneous transhepatic stent for internal and external biliary drainage Change of percutaneous biliary drainage catheter Revision and/or reinsertion of transhepatic tube Insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous $487
$0
0.00%
NA
NA
NA
$597
($1)
‐0.18%
NA
NA
NA
$87
$364
$0
$2
0.00%
0.49%
$528
$1,399
$7
$4
1.30%
0.31%
$238
$3
1.07%
NA
NA
NA
$186
$0
0.19%
NA
NA
NA
Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure)
$75
$0
0.00%
$557
$2
0.39%
26
Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation
$74
$1
0.98%
$74
$1
0.98%
75982
26
Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation
$73
$0
0.49%
$73
$0
0.49%
75984
26
Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation
$36
$0
0.00%
$36
$0
0.00%
47511
47525
47530
49421
50392
49423
75980
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
22
Modifier
Table 3: Physician Fee Schedule CY2015 Proposed Rule Payment Rates
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed vs. Proposed In‐
CPT®
Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Rhythm Management
Device Implant Procedures
$477
$5
1.14%
NA
NA
NA
33206
Insertion of heart pacemaker and atrial electrode
33207
Insertion of heart pacemaker and ventricular electrode
$507
$4
0.85%
NA
NA
NA
33208
Insertion of heart pacemaker with transvenous electrode
$549
$5
0.86%
NA
NA
NA
33212
Insertion of pulse generator only with existing single lead
$343
$2
0.53%
NA
NA
NA
33213
Insertion of pulse generator only with existing dual lead
$358
$2
0.50%
NA
NA
NA
33221
Insertion of pulse generator only with existing mulitple leads
$384
$5
1.32%
NA
NA
NA
33214
33215
33216
33217
33218
33220
33222
33223
33225
Upgrade of pacemaker system
Reposition pacing‐defib lead
Insert lead pace‐defib, one
Insert lead pace‐defib, dual
Repair of single lead, pacer or ICD
Repair of 2 leads, pacer or ICD
Revise/relocate pocket, pacemaker
Revise pocket, defib
L ventric pacing lead (add‐on)
$503
$318
$394
$387
$413
$413
$359
$433
$483
$1
$2
$4
$2
$6
$3
$2
$3
$5
0.14%
0.68%
1.10%
0.56%
1.41%
0.70%
0.60%
0.75%
0.97%
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
33227
Removal and replacement of pacemaker gen, single lead
$361
$2
0.50%
NA
NA
NA
33228
Removal and replacement of pacemaker gen, dual lead
$376
$2
0.57%
NA
NA
NA
33229
Removal and replacement of pacemaker gen, multiple lead
$396
$3
0.73%
NA
NA
NA
33233
33234
33235
33240
33230
Removal of pacemaker system gen only
Removal of pacemaker system lead, single
Removal pacemaker electrode, dual lead
Insert pulse generator with exisitng single lead
Insert ICD pulse generator with exisitng dual leads
$250
$512
$667
$389
$407
$3
$6
$6
$1
($2)
1.31%
1.13%
0.87%
0.37%
‐0.44%
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
33231
Insert ICD pulse generator with exisitng multiple leads
$429
$8
1.87%
NA
NA
NA
33241
33262
33263
Remove pulse generator only
Removal and replacement of defib gen, single lead
Removal and replacement of defib gen, dual lead
$235
$397
$413
$3
$3
$3
1.23%
0.73%
0.79%
NA
NA
NA
NA
NA
NA
NA
NA
NA
33264
Removal and replacement of defib gen, multiple lead
$429
$3
0.59%
NA
NA
NA
$896
$955
$8
$10
0.89%
1.02%
NA
NA
NA
NA
NA
NA
$342
NA
NA
$22
NA
NA
$4
NA
NA
$1
NA
NA
1.06%
NA
NA
3.39%
NA
NA
$342
$38
$16
$22
$50
$18
$4
$1
$0
$1
$0
$0
1.06%
1.94%
0.00%
3.39%
0.00%
2.08%
33244
Remove eltrd, transven
33249
Eltrd/insert pace‐defib
Device Evaluation
93641 26 Electrophysiology evaluation ‐ICD system
93288
93288 TC PM Interrogation in person all lead configurations
93288 26
93279
93279 TC PM Programming eval 1 lead
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
23
93279
93280
93280
93280
93281
93281
93281
93289
93289
93289
93282
93282
93282
93283
93283
93283
93284
93284
93284
93291
93291
93291
93285
93285
93285
93290
93290
93290
93292
93292
93292
93286
93286
93286
93287
93287
93287
93293
93293
93293
93228
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
26
$33
($0)
‐1.09%
$33
($0)
‐1.09%
NA
NA
NA
$59
$0
0.00%
TC PM Programming eval 2 lead
NA
NA
NA
$20
$0
0.00%
26
$39
$0
0.00%
$39
$0
0.00%
NA
NA
NA
$69
$0
0.52%
TC PM Programming eval 3 lead
NA
NA
NA
$23
$0
1.56%
26
$45
$0
0.00%
$45
$0
0.00%
NA
NA
NA
$66
$0
0.55%
TC ICD interrogation in person all lead configurations
NA
NA
NA
$20
$0
1.85%
26
$46
$0
0.00%
$46
$0
0.00%
NA
NA
NA
$64
$1
1.14%
TC ICD Programming eval 1 lead
NA
NA
NA
$20
$0
1.79%
26
$43
$0
0.83%
$43
$0
0.83%
NA
NA
NA
$82
$0
0.44%
TC ICD Programming eval 2 lead
NA
NA
NA
$24
$0
1.52%
26
$58
$0
0.00%
$58
$0
0.00%
NA
NA
NA
$91
$1
0.79%
TC ICD Programming eval 3 lead
NA
NA
NA
$27
$0
1.33%
26
$64
$0
0.56%
$64
$0
0.56%
NA
NA
NA
$37
$0
0.99%
TC ILR Innterrogation in person
NA
NA
NA
$15
$0
0.00%
26
$22
$0
1.67%
$22
$0
1.67%
NA
NA
NA
$43
$1
1.71%
TC ILR Programming eval
NA
NA
NA
$16
$0
2.27%
26
$27
$0
1.37%
$27
$0
1.37%
NA
NA
NA
$32
$1
2.33%
TC ICM Interrogation in person
NA
NA
NA
$10
$0
3.85%
26
$22
$0
1.67%
$22
$0
1.67%
NA
NA
NA
$33
$1
3.37%
TC Wearable defib Interrogation in person
NA
NA
NA
$11
$0
3.33%
26
$22
$1
3.39%
$22
$1
3.39%
NA
NA
NA
$28
$0
1.32%
TC PM Peri‐px eval and programming
NA
NA
NA
$12
$0
3.03%
26
$15
$0
0.00%
$15
$0
0.00%
NA
NA
NA
$37
$1
2.00%
TC ICD Peri‐px eval and programming
NA
NA
NA
$13
$0
2.78%
26
$23
$0
1.56%
$23
$0
1.56%
NA
NA
NA
$54
$0
0.67%
TC TTM rhythm strip pacemaker eval
NA
NA
NA
$38
$0
0.95%
26
$16
$0
0.00%
$16
$0
0.00%
Wearable defib mobile telemetry w/phy r&I w/report
93294
PM Remote Interrogation 90 days all lead config
93295
ICD Remote interrogation 90 days all lead config
93296
PE‐ Remote data aquisition PM or ICD
93297
ICM Remote interrogation eval 30 days
93298
ILR Remote interrogation eval 30 days
93299
ICM and ILR Remote interr 30 days, tech
Diagnostic Catheterization
93462
L hrt cath trnsptl puncture
$27
$0
0.00%
$27
$0
0.00%
$34
$68
NA
$27
$27
$0
$0
$0
NA
$0
$0
$0
1.05%
0.53%
NA
1.35%
0.00%
NA
$34
$68
$26
$27
$27
$0
$0
$0
$0
$0
$0
$0
1.05%
0.53%
1.39%
1.35%
0.00%
NA
$214
($0)
‐0.17%
$214
($0)
‐0.17%
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
24
CPT®
Modifier
93609
26
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
Intraventricular and/or intra‐atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (add on)
$290
$4
1.25%
$290
$4
1.25%
93613
Intracardiac electrophysiologic 3‐dimensional mapping (add on)
$408
$5
1.33%
NA
NA
NA
93619
26
Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, HIS bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia
$423
$4
0.85%
$423
$4
0.85%
93620
26
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording
$671
$5
0.75%
$671
$5
0.75%
93621
26
93622
26
93623
26
with left atrial pacing and recording from coronary sinus or left atrium (add on)
with left ventricular pacing and recording (add on)
Programmed stimulation and pacing after intravenous drug infusion (add on)
$122
$1
1.19%
$122
$1
1.19%
$178
$1
0.61%
$178
$1
0.61%
$166
$2
1.09%
$166
$2
1.09%
93650
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement
$622
$6
1.05%
NA
NA
NA
93653
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, HIS recording, with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventiricular tachycardia by ablation of fast or slow atrioventricular pathyway, accessory atrioventricular connection, cavo‐tricuspid isthmus or other single atrial focus or source of atrial re‐entry.
$874
$9
1.04%
NA
NA
NA
93654
with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed
$1,163
$11
0.93%
NA
NA
NA
93655
Intracardiac catheter ablation of a descrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (add on)
$437
$4
0.99%
NA
NA
NA
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
25
Modifier
CPT®
Note: Rates subject to change and do NOT reflect the 20.1% SGR reduction expected to be addressed by Congress
2015 Variance 2015 Variance 2015 2015 Proposed Proposed vs. Proposed In‐ Proposed vs. Abbreviated (Partial) Description
In‐Office 2014 Final
2014 Final
Facility Rate
Rate
$
$
%
$
$
%
93656
Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, HIS bundle recording with intracardiac catheter ablation of arrhytmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation
93657
Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (add on)
$1,168
$14
1.24%
NA
NA
NA
$436
$4
0.83%
NA
NA
NA
$1
0.73%
$148
$1
0.73%
Intracardiac echocardiography during therapeutic/diagnostic $148
intervention, including imaging supervision and interpretation (add on)
BSC currently has no FDA‐approved ablation catheters for the treatment of atrial fibrillation
93662
26
Common Procedural Terminology (CPT) copyright 2013 American Medical Association. All rights reserved.
Important Information‐‐Please Note:
• Please note: this coding information may include some codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. • National average final base payment amounts. Specific payment rates may change due to geographic wage differences.
• Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all‐inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
See page 6 and 26 for important information about the uses and limitations of this document.
Copyright © 2014 by Boston Scientific Corporation or its affiliates. All rights reserved. CRV-171008-AB JUL2014
26