CY2015 Medicare Final Rules Issued for Hospital Outpatient, Ambulatory Surgical Center and Physician Fee Schedule Interventional Cardiology, Peripheral Interventions, Rhythm Management Summary: On October 31, 2014, the Centers for Medicare and Medicaid Services (CMS) released Calendar Year (CY) 2015 final policy and payment rates for Medicare’s Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASC). CMS also released the CY2015 final rule and payment rates for the Physician Fee Schedule (PFS). The final policy and payment rates are effective January 1, 2015. Hospital Outpatient Ambulatory Payment Classification (APC): Average rates for outpatient services increase by 2.2% in CY2015. See Table 1 for interventional cardiology, peripheral interventions, and rhythm management related procedures. Significant HOPPS Policy Changes Affect Many Cardiovascular Procedures Comprehensive APCs – CMS finalized the implementation of 25 Comprehensive APC to further efforts to pay providers for quality, not quantity of care. A comprehensive APC (c-APC) packages payments for services and supplies rather than providing separate multiple payments for each individual service. In CY2015, c-APCs will provide a single all-inclusive payment for the primary service with no additional reimbursement for additional adjunctive services and supplies used during the delivery of the primary service. As part of its c-APC system, CMS created 12 clinical families (for example vascular) to reflect clinical homogeneity and resource utilization identification of c-APCs. To ensure appropriate accounting of all resources, CMS is also applying complexity criteria for multiple procedure combinations performed on the same date of service to allow for mapping to a higher APC within that clinical family of procedures. Packaged Services – CMS expanded their Packaging Policy implemented in CY2014 by adding procedure add-on codes (except drug administration and codes defined for a complexity adjustment when reported with the primary service), and some low cost ancillary services with a Q1 status indicator. 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 vessel procedures and the other services indicated above. CMS will pay one bundled payment based on the main/primary procedure or initial service code on a claim. A new status indicator “J1” will be assigned to the packaged CPT codes. Place of Service – In an effort to understand the growing trend toward off-campus provider based outpatient facilities, CMS plans to implement a modifier for procedures provided in an off-campus department of a hospital while physicians and other practitioners will report using a new place of service code. Reporting of the yet to be announced code will be voluntary in CY2015, and required for applicable services in CY2016. Interventional Cardiology Comprehensive APCs positively affect the level of reimbursement for Percutaneous Coronary Intervention (PCI) procedures. 

PCI drug-eluting stent procedures with atherectomy, CTO, AMI, payment rates are $14,841. The same payment rate applies to or BMS with atherectomy. This compares to a range of CY2014 rates for these procedures of $6,364 to $7,714. Complexity adjustments, including second main coronary vessel, or additional branch vessel, when in combination with DES or DES bypass graft will group to higher paying APC 0319. (See Table 1 for a list of interventional cardiology combination codes) It should also be noted that this payment is $2,766 greater than the national average for inpatient MS-DRG 247 Percutaneous cardiovascular procedures without MCC.



Drug-eluting stent with PTCA, BMS procedures, or atherectomy without stent final payment rates will be $9,624 compared to a CY2014 range of $6,364 to $8,843

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

CRV-278904-AA NOV2014 1 of 26

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Peripheral Interventions 

Iliac, Femoral/Popliteal, and Hemodialysis Access Management (HAM) PTA payments increase by 3% to $4,537



Tibial/Peroneal PTA increased by 118% to $9,624



Iliac and ,Femoral/Popliteal Stenting (with PTA) payments increase by 5% to $9,624



Tibial/Peroneal Stenting (with PTA) payments increase by 63% to $14,841



Combined PTA, Stent and atherectomy procedures decrease 4% to $14,841



Embolization procedures increase 9% to $9,624 which reflects a change from APC 0082 to 0229



AV Fistula Thrombectomy procedures increase 47% to $4,537

Rhythm Management 

CMS finalized reassignment of 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 payment increase is ~ $5,788 or 23% for CY2015. This change fully maps all facility S-ICD procedures to the same payment categories as transvenous ICDs procedures.



The complexity-adjusted methodology associated with c-APCs results in payment increases for CRT-D replacements, CRT-P system implants and AV node ablation with pacemaker implants.



Single and dual chamber pacemaker implant decrease by 10.3%



Defibrillator system implants decrease by 4.17%



Defibrillator replacements decrease by 8.43%



Comprehensive EP studies in conjunction with ablation procedures increase by 9.5%



Left atrial appendage closure procedure (0281T) is restricted to the inpatient hospital site of service; therefore, there is no payment when performed in the outpatient hospital

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 they receive up to a two percentage point reduction in their annual payment update (APU). CMS did not finalize removing the measure OQR-4: Aspirin at Arrival, as performance is still low in some hospitals. Ambulatory Surgical Center: Overall ASC payments increase 1.4% over CY2014 rates. See Table 2 for peripheral interventions, and rhythm management related procedures. Peripheral Interventions 

All lower extremity bundled PTA, stent and atherectomy procedures are allowed in the ASC; however, less than 1% of PI procedures are 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 increase by 19% to ~$27,000



CRT-D system implants decrease by 8.1%



ICD system implants decrease by 8.1%



ICD PG only payment rates decrease by 11.3%



Dual chamber pacemaker system implant payment rates decrease by 15.4%, while dual chamber pacemaker PG only payment rates increase by 8.2%

CRV-278904-AA NOV2014 2 of 26

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

Physician: Table 3 final rates are calculated using the current conversion factor of $35.8013 which is effective through March 31, 2015 as a result of the recent Sustainable Growth Rate (SGR) patch passed earlier this year. While CMS is mandated by law to reduce payment by 21.2% effective April 1, 2015, the expectation is that Congress will once again provide a short-term fix to minimize the SGR which may impact rates. The overall average change for select procedures is as follows: In-Facility

In-Office

Interventional Cardiology

Increase 0.33%

N/A

Peripheral Interventions

Decrease 1.67%

Increase 1.13%

Rhythm Management

Increase 0.32%

Increase 0.94%

Interventional Cardiology Coronary Stenting  

PCIs payment rates are relatively stable o CTO and AMI PCIs decrease by $3 to $696. o Atherectomy with stent payment rate decrease $3 to $695 Stent\PTCA payment rate will decrease by $2 to $621

Structural Heart-Valves 

TAVR range of codes stable, down slightly by 0.6%

Peripheral Interventions Physician In-Facility reimbursement is decreasing 1.67%. Reimbursement to physicians for procedures done in their office increases 1.13%. 

Atherectomy payments increase 0.7% to $12,778



HAM payments decrease 2.6% to $1,520



Embolization payments increase 1% to $7,373



Vascular Stent (non-LE / non-carotid) payments increase 47% to $4,208

Rhythm Management 

Physician Quality Report System (PQRS) - Additional PQRS reporting measures for 2015 have been added o Cardiac Tamponade and/or Pericardiocentesis following Atrial Fibrillation Ablation o Infection within 180 days of Cardiac Implantable Electronic Device (CIED) Implantation, Replacement, or Revision



New S-ICD Category I CPT codes published for 2015



Some ICD code descriptions were modified to allow for inclusion of S-ICD



Payment rates for device implants remain stable at a 0.25% increase



Ablation payment rates remain stable at a 0.38% increase

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 plans to transition all 10 and 90 day global period codes to 0-global days starting in CY2017. 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 CY2015, CMS adds 20 new individual measures and two measures groups to fill existing measure gaps. The Agency will remove 50 measures from reporting for the PQRS. These changes would bring the PQRS individual measure set to 255 total measures.

CRV-278904-AA NOV2014 3 of 26

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Implementation of Physician Value-Based Modifier - CMS finalized the implementation of the value-based modifier for physicians as required by the Affordable Care Act. This modifier applies to physicians groups of two or more eligible professionals for participating in the Physician Quality Reporting System (PQRS). Solo practitioners will be added in 2017. The CY2016 maximum penalty will be capped at 2% but starting in 2017 will increase to 4% for practices with 10 or more eligible professionals. The smaller groups will still be capped at a maximum of 2% in CY2017. Table Index At the end of the document the following three tables list detailed changes for select Interventional Cardiology (IC), Peripheral Intervention (PI), and Rhythm Management (RM), (reflective of Cardiac Rhythm Management and Electrophysiology) related procedures: Table 1: Hospital Outpatient CY2015 Final Payment Rates Table 2: ASC CY2015 Final Payment Rates Table 3: Physician CY2015 Final Fee Schedule (Final rates calculated with current conversion factor of $35.8013 effective through March 31, 2015--Subject to change April 1, 2015 due to the 21.2% SGR reduction that will most likely be addressed by Congress) 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

Deb Lorenz—IC

Brent Hale--PI

763-494-2016

763-494-2112

763-494-1448

[email protected]

[email protected]

[email protected]

Rhythm Management (RM) Call 1-800-CARDIAC (request reimbursement support) [email protected]

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

CRV-278904-AA NOV2014 4 of 26

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

Table 1: CY2015 Hospital Outpatient Final Payment Rates for Select Procedures APC

Descriptor

Interventional Cardiology 0080 Diagnostic Cardiac Catheterization 0082 Coronary or Non‐Coronary Atherectomy Level I Endovascular Procedures 0083 * PTCA (92920) 0104 Transcatheter Placement of Intracoronary Stents 0656

*

*

*

*

*

CY2015 Final  CY2014 Final  Rate Rate

$2,575 $4,537 $4,537

$2,587 ‐$12 Deleted in CY2015 $4,410 $127 $4,410 $127 Deleted in CY2015

% YoY  Change

‐0.45% 2.88% 2.88%

Deleted in CY2015

Transcatheter Placement of Intracoronary Drug‐Eluting Stents

Level II Endovascular Procedures (Previous APC 104) PTCA + PTCA (92920 + 92920) PTCA + PTCA add branch (92920 + 92921) 0229 BMS w/PTCA (92928) BMS Bypass Graft (92937) BMS AMI PCI (92941) BMS CTO PCI (92943) Level II Endovascular Procedures (Previous APC 656) DES w/PTCA (C9600) 0229 DES Bypass Graft (C9604) PTCA/Atherectomy (92924) Level III Endovascular Procedures (Previous APC 104) 0319 BMS w/Atherectomy (92933) BMS Stent + DES Stent add branch (92928 + C9601) Level III Endovascular Procedures (Previous APC 656) DES w/Atherectomy (C9602) DES AMI PCI (C9606) DES CTO PCI (C9607) DES + Insert Pacemaker (C9600 + 33208) DES + Insert Electrode (C9600 + 33210) DES + Vasc Stent (C9600 + 37236) DES + Iliac Stent (C9600 + 37221) 0319 DES + Coronary Angio / Atherectomy (C9600 + 92924) DES + DES (C9600 + C9600) DES + DES add branch (C9600 + C9601) DES + DES Bypass Graft add branch (C9600 + C9605) DES Bypass Graft + DES (C9604 + C9600) DES Bypass Graft + DES add branch (C9604 + C9601) DES Bypass Graft + DES Bypass Graft (C9604 + C9604) DES Bypass Graft + DES Bypass Graft add branch (C9604 +  C9605) Peripheral Interventions 0082 Coronary or Non‐Coronary Atherectomy Level I Endovascular Procedures (PTA) 0083 Iliac PTA (37220) FemPop PTA (37224) 0088 Thrombectomy 0093 Vascular Reconstruction/Fistula Repair Level I Percutaneous Abdominal and Biliary Procedures (Biliary  0152 Stenting) Level II Cystourethroscopy and other Genitourinary  0161 Procedures

Variance  2015 Final vs.  2014 Final

$9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $9,624 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841 $14,841

$6,364 $6,615 $6,615 $6,364 $6,364 $6,364 $6,364 $7,714 $7,714 $7,714 $8,843 $6,364 $6,364 $10,896 $7,714 $7,714 $7,714 $7,714 $14,445 $11,391 $12,274 $12,976 $12,699 $11,571 $11,571 $11,571 $11,571 $11,571 $11,571

$3,260 $3,009 $3,009 $3,260 $3,260 $3,260 $3,260 $1,910 $1,910 $1,910 $781 $8,477 $8,477 $3,945 $7,127 $7,127 $7,127 $7,127 $396 $3,450 $2,567 $1,865 $2,142 $3,270 $3,270 $3,270 $3,270 $3,270 $3,270

51.23% 45.49% 45.49% 51.23% 51.23% 51.23% 51.23% 24.76% 24.76% 24.76% 8.83% 133.20% 133.20% 36.21% 92.39% 92.39% 92.39% 92.39% 2.74% 30.29% 20.91% 14.37% 16.87% 28.26% 28.26% 28.26% 28.26% 28.26% 28.26%

$14,841

$11,571

$3,270

28.26%

$4,537 $4,537 $4,537 $3,220 $2,500

Deleted in CY2015 $4,410 $127 $4,410 $127 $4,410 $127 $3,272 ‐$52 $2,847 ‐$347

2.88% 2.88% 2.88% ‐1.59% ‐12.17%

$1,833

$1,788

$44

2.48%

$1,226

$1,205

$22

1.80%

CRV-278904-AA NOV2014 5 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

Table 1: CY2015 Hospital Outpatient Final Payment Rates for Select Procedures APC

*

0229

Descriptor

CY2015 Final  CY2014 Final  Rate Rate

0090

% YoY  Change

Level II Endovascular Procedures (PTA & Stent, Embolization)

$9,624

$9,120

$504

5.53%

TibPer PTA (37228) Iliac Stent (37221) FemPop Atherectomy (37225) FemPop Stent (37226)

$9,624 $9,624 $9,624 $9,624

$9,120 $9,120 $9,120 $9,120

$504 $504 $504 $504

5.53% 5.53% 5.53% 5.53%

Level III Endovascular Procedures (PTA, Stent & Atherectomy)

$14,841

$15,510

‐$669

‐4.32%

$5,721 $5,721 ‐$669 ‐$669 $1,161 $1,161 $1,161 $1,161 $1,161 $1,161 $1,161 ‐$1,993 $1,299 $1,299 $1,299 $1,299 $1,299 $1,299 $1,299 $1,299 $255 ‐$18 ‐$130 $0 $11 ‐$1,253

62.73% 62.73% ‐4.31% ‐4.31% 8.49% 8.49% 8.49% 8.49% 8.49% 8.49% 8.49% ‐11.84% 9.59% 9.59% 9.59% 9.59% 9.59% 9.59% 9.59% 9.59% 12.75% ‐1.35% ‐5.36% 0.03% 6.18% ‐7.44%

‐$1,098

‐10.37%

‐$2,258

‐19.22%

$14,841 $9,120 TibPer Atherectomy (37229) ‐ Previously APC 229 $14,841 $9,120 TibPer Stent (37230) ‐ Previously APC 229 $14,841 $15,510 FemPop PTA, Stent & Atherectomy (37227) $14,841 $15,510 TibPer PTA, Stent & Atherectomy (37231) Iliac Stent + Vasc Stent (37221 + 37236) $14,841 $13,680 FemPop Atherectomy + Iliac Stent (37225 + 37221) $14,841 $13,680 FemPop Atherectomy + Vasc Stent (37225 + 37236) $14,841 $13,680 FemPop Stent + Iliac Stent (37226 + 37221) $14,841 $13,680 FemPop Stent + FemPop Atherectomy (37226 + 37225) $14,841 $13,680 * 0319 $13,680 FemPop Stent + FemPop Stent (37226 + 37226) $14,841 FemPop Stent + Vasc Stent (37226 + 37236) $14,841 $13,680 FemPop Stent + DES (37226 + C9600) $14,841 $16,834 Vasc embo venous + Vasc stent (37241 + 37238) $14,841 $13,542 Vasc embo artery + Iliac stent (37242 + 37221) $14,841 $13,542 Vasc embo artery + Vasc stent (37242 + 37236) $14,841 $13,542 Vasc embo organ + Iliac stent (37243 + 37221) $14,841 $13,542 Vasc embo organ + Vasc stent (37243 + 37236) $14,841 $13,542 Vasc embo bleed + Iliac stent (37244 + 37221) $14,841 $13,542 Vasc embo bleed + Vasc stent (37244 + 37236) $14,841 $13,542 Vasc embo bleed + Vasc stent (37244 + 37238) $14,841 $13,542 0415 $2,255 $2,000 Level II Endoscopy Lower Airway 0427 $1,289 $1,306 Level II Tube Changes and Repositioning 0652 Insertion of Intraperitoneal and Pleural Catheters $2,287 $2,417 0668 $827 $827 Level I Angiography and Venography 0676 $195 $184 Thrombolysis and Other Device Revisions  2616 $15,577 $16,829 Brachytherapy, non‐str,Yttrium‐90 BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities Rhythm Management Level III Pacemaker and Similar Procedures (PM system,  $9,490 $10,588 Previous APC 0655) Removal of pm generator + L entric pacing lead add‐on (33233  $9,490 $11,747 * 0089 + 33225) Implant pat‐active ht record + EP Eval (33282 + 93619) $9,490 $8,339 *

Variance  2015 Final vs.  2014 Final

Implant pat‐active ht record + EP Eval (33282 + 93620) Level II Pacemaker and Similar Procedures (PM replacement or  lead only)

$1,151

13.80%

$9,490

$8,339

$1,151

13.80%

$6,543

$7,353

‐$810

‐11.02%

CRV-278904-AA NOV2014 6 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

Table 1: CY2015 Hospital Outpatient Final Payment Rates for Select Procedures APC

*

0655

Descriptor

CY2015 Final  CY2014 Final  Rate Rate

Variance  2015 Final vs.  2014 Final

% YoY  Change

Level IV Pacemaker and Similar Procedures (CRT‐P)

$16,401

$10,588

$5,813

54.90%

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

$16,401

$14,984

$1,417

9.46%

$16,401

$15,883

$518

3.26%

$16,401

$12,705

$3,696

29.09%

$16,401

$12,889

$3,512

27.24%

$16,401

$14,782

$1,619

10.95%

Insert PM atrial & Vent + L ventric pacing lead add‐on (33208 +  33225) Insert PM atrial & vent + Ablate heart dys focus (33208 +  93650) Insert pacing lead & connect + Insert 1 electrode pm‐defib  (33224 + 33216) Remv&replc pm gen dual lead + L ventric pacing lead add‐on  (33228 + 33225)

*

0108

S‐ICD Implant ‐ Level II ICD and Similar Procedures (Previous  APC 0107) S‐ICD System Implant (PG + Lead) or CRT‐D  replacement

$30,806

$25,018

$5,788

23.14%

*

0108

Level II ICD and Similar Procedures (ICD or CRTD System)

$30,806

$32,145

‐$1,339

‐4.16%

*

0107

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

$22,908

$25,018

‐$2,111

‐8.44%

* *

0080 0084 0085

Diagnostic Cardiac Catheterization Level I EP Procedures Level II EP Procedures

$2,575 $873 $4,633

$2,587 $754 $4,233

‐$12 $119 $401

‐0.45% 15.73% 9.46%

*

0086

Level III Electrophysiologic Procedures (EP study + Ablation, Previous APC 8000)

$14,357

$13,115

$1,242

9.47%

* Symbol notes comprehensive APC Common Procedural Terminology (CPT) copyright 2014 American Medical Association.  All rights reserved.

CRV-278904-AA NOV2014 7 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

Table 2: Ambulatory Surgical Center (ASC) ASC CY2015 Final Payment Rates for Select Procedures CPT®

Abbreviated (Partial) Description

CY2015 Final  CY2014 Final  Payment Payment

Variance 2015 Final vs.  2014 Final

$

$

$

%

$1,245

$923

$322

34.82%

$1,320

$978

$342

34.92%

$2,220

$2,436

($216)

‐8.87%

$6,061

$5,038

$1,023

20.31%

$2,220

$1,703

$517

30.37%

$1,765

$1,807

($42)

‐2.32%

$1,237

$1,105

$132

11.92%

$2,245

$2,268

($23)

‐1.03%

$1,005 $707 $707 $1,254 $673 $707

$988 $722 $722 $1,335 $666 $722

$17 ($15) ($15) ($81) $7 ($15)

1.72% ‐2.08% ‐2.08% ‐6.06% 1.05% ‐2.08%

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

* 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

CRV-278904-AA NOV2014 8 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

Table 2: Ambulatory Surgical Center (ASC) ASC CY2015 Final Payment Rates for Select Procedures CPT®

Abbreviated (Partial) Description

33249 33262 33270

33249 +  33225

Variance 2015 Final vs.  2014 Final

$

$

$

%

$7,851 $7,851

$9,286 $7,256

($1,435) $595

‐15.45% 8.21%

$20,286

$22,882

($2,595)

‐11.34%

$27,204

$29,600

($2,396)

‐8.10%

$20,286

$22,882

($2,595)

‐11.34%

S-ICD system implant

$27,204

$22,882

$4,322

18.89%

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

$27,204

$29,600

($2,396)

‐8.09%

Rhythm Management Pacemaker ‐ dual chamber system implant 33208 Pacemaker ‐ dual chamber pulse generator only 33213 33240

CY2015 Final  CY2014 Final  Payment Payment

Insertion of ICD / S‐ICD pulse generator only with existing lead  ICD system implant Removal with replacement of ICD / S‐ICD pulse generator only with  * existing electrode 

* Code 33270 is new CPT code for reporting S‐ICD System implants in CY2015. AMA approved new CPT 1 codes for S‐ICD procedures effective  01.01.2015.

CRV-278904-AA NOV2014 9 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Table 3: Physician Fee Schedule CY2015 Final Rule Payment Rates Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

Rhythm Management Device Implant Procedures 33206 Insertion of heart pacemaker and atrial electrode

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$478

$6

1.23%

NA

NA

NA

33207

Insertion of heart pacemaker and ventricular electrode

$508

$5

1.01%

NA

NA

NA

33208

Insertion of heart pacemaker with transvenous electrode

$550

$5

0.99%

NA

NA

NA

33212

Insertion of pulse generator only with existing single lead

$344

$3

0.78%

NA

NA

NA

33213

Insertion of pulse generator only with existing dual lead

$359

$3

0.84%

NA

NA

NA

33221

Insertion of pulse generator only with existing mulitple leads

$385

$6

1.55%

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)

$504 $319 $395 $388 $415 $414 $360 $433 $483

$1 $3 $5 $3 $7 $3 $3 $3 $5

0.30% 0.96% 1.32% 0.87% 1.70% 0.81% 0.84% 0.77% 1.14%

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

$362

$3

0.74%

NA

NA

NA

33228

Removal and replacement of pacemaker gen, dual lead

$378

$3

0.90%

NA

NA

NA

33229

Removal and replacement of pacemaker gen, multiple lead

$397

$4

0.94%

NA

NA

NA

33230

Insert ICD pulse generator with exisitng dual leads

$406

($2)

‐0.50%

NA

NA

NA

33231

Insert ICD pulse generator with exisitng multiple leads

$429

$8

1.81%

NA

NA

NA

33233 33234 33235

Removal of pacemaker system gen only Removal of pacemaker system lead, single Removal pacemaker electrode, dual lead Insertion of implantable defibrillator pulse generator only; with  existing single lead 

$250 $514 $667

$4 $7 $6

1.54% 1.42% 0.97%

NA NA NA

NA NA NA

NA NA NA

$390

$2

0.59%

NA

NA

NA

33240 33241

Removal of implantable defibrillator pulse generator only

$236

$4

1.64%

NA

NA

NA

33262

Removal of implantable defibrillator pulse generator with  replacement of implantable defibrillator pulse generator; single  lead system

$397

$4

0.94%

NA

NA

NA

1.64% 0.94% 0.81%

NA NA NA

NA NA NA

NA NA NA

33240, 33241, 33262 include revisions to an existing code 33241 33262 33263

Remove pulse generator only Removal and replacement of defib gen, single lead Removal and replacement of defib gen, dual lead

$236 $397 $413

$4 $4 $3

CRV-278904-AA NOV2014 10 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

33264

Removal and replacement of defib gen, multiple lead

$430

$3

0.78%

NA

NA

NA

33244 33249

Remove eltrd, transven Eltrd/insert pace‐defib

$898 $957

$10 $11

1.11% 1.19%

NA NA

NA NA

NA NA

33270

Insertion or replacement of permanent S‐ICD system, with  subcutaneous electrode, including DFT, when performed 

$657

NA

NA

NA

NA

NA

33271

Insertion of S‐ICD electrode 

$499

NA

NA

NA

NA

NA

33270 and 33271 modified from Final Rule to reflect correction as In‐Facility Rate 33272

Removal of S‐ICD electrode 

$445

NA

NA

NA

NA

NA

33273

Repositioning of previously implanted S‐ICD electrode 

$402

NA

NA

NA

NA

NA

$343 NA NA $45 NA NA $39 NA NA $21 NA NA $33 NA NA $39 NA NA $45 NA NA $46 NA NA $43 NA NA $58 NA NA $63 NA NA

$4 NA NA NA NA NA NA NA NA $0 NA NA ($0) NA NA ($0) NA NA ($0) NA NA ($0) NA NA $0 NA NA ($0) NA NA ($0) NA NA

1.21% NA NA NA NA NA NA NA NA 1.63% NA NA ‐1.15% NA NA ‐0.06% NA NA ‐0.06% NA NA ‐0.06% NA NA 0.77% NA NA ‐0.06% NA NA ‐0.06% NA NA

$343 $66 $21 $45 $61 $21 $39 $37 $16 $21 $50 $18 $33 $59 $20 $39 $69 $23 $45 $66 $20 $46 $64 $21 $43 $82 $24 $58 $91 $27 $63 $37 $15

$4 NA NA NA NA NA NA $0 ($0) $0 ($0) $0 ($0) ($0) ($0) ($0) $0 $0 ($0) $0 $0 ($0) $1 $1 $0 $0 $0 ($0) $0 $0 ($0) $0 ($0)

1.21% NA NA NA NA NA NA 0.91% ‐0.06% 1.63% ‐0.06% 2.02% ‐1.15% ‐0.06% ‐0.06% ‐0.06% 0.46% 1.50% ‐0.06% 0.49% 1.79% ‐0.06% 1.64% 3.51% 0.77% 0.38% 1.45% ‐0.06% 0.34% 1.27% ‐0.06% 0.93% ‐0.06%

$22

$0

1.61%

$22

$0

1.61%

Device Evaluation 93641 26 Electrophysiology evaluation ‐ICD system 93260 S‐ICD Programming device evaluation (in person)  93260 TC 93260 26 93261 S‐ICD Interrogation device evaluation (in person)  93261 TC 93261 26 93288 93288 TC PM Interrogation in person all lead configurations 93288 26 93279 93279 TC PM Programming eval 1 lead 93279 26 93280 93280 TC PM Programming eval 2 lead 93280 26 93281 93281 TC PM Programming eval 3 lead 93281 26 93289 93289 TC ICD interrogation in person all lead configurations 93289 26 93282 93282 TC ICD Programming eval 1 lead 93282 26 93283 93283 TC ICD Programming eval 2 lead 93283 26 93284 93284 TC ICD Programming eval 3 lead 93284 26 93291 93291 TC ILR Innterrogation in person 93291 26

CRV-278904-AA NOV2014 11 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $ NA NA

$ NA NA

% NA NA

$ $43 $16

$ $1 $0

% 1.65% 2.21%

$26

$0

1.31%

$26

$0

1.31%

NA NA $21 NA NA

NA NA ($0) NA NA

NA NA ‐0.06% NA NA

$31 $10 $21 $33 $11

$0 $0 ($0) $1 $0

1.10% 3.78% ‐0.06% 2.19% 3.27%

$21

$0

1.63%

$21

$0

1.63%

NA NA $15 NA NA $23 NA NA $16

NA NA ($0) NA NA $0 NA NA ($0)

NA NA ‐0.06% NA NA 1.50% NA NA ‐2.28%

$28 $12 $15 $37 $13 $23 $54 $38 $16

$0 $0 ($0) $1 $0 $0 ($0) $0 ($0)

1.25% 2.97% ‐0.06% 1.94% 2.72% 1.50% ‐0.06% 0.89% ‐2.28%

$26

($0)

‐0.06%

$26

($0)

‐0.06%

$34 $68 NA $27 $27 $0

$0 $0 NA $0 ($0) $0

0.99% 0.47% NA 1.29% ‐0.06% NA

$34 $68 $26 $27 $27 $0

$0 $0 $0 $0 ($0) $0

0.99% 0.47% 1.33% 1.29% ‐0.06% NA

$215

$0

0.11%

$215

$0

0.11%

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)

$291

$4

1.44%

$291

$4

1.44%

93613

Intracardiac electrophysiologic 3‐dimensional mapping (add on)

$409

$6

1.45%

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

0.97%

$423

$4

0.97%

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

$673

$7

1.01%

$673

$7

1.01%

93285 93285

TC

93285

26

93290 93290 93290 93292 93292 93292 93286 93286 93286 93287 93287 93287 93293 93293 93293

TC 26 TC

ILR Programming eval

ICM Interrogation in person

Wearable defib Interrogation in person

26 TC 26

PM Peri‐px eval and programming

TC 26

ICD Peri‐px eval and programming

TC 26

TTM rhythm strip pacemaker eval

93228

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 93609

93620

26

CRV-278904-AA NOV2014 12 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

93621

26

93622

26

93623

26

93644

Abbreviated (Partial) Description

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) EP Evaluation of S‐ICD

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$123

$2

1.72%

$123

$2

1.72%

$179

$2

0.95%

$179

$2

0.95%

$166

$2

1.25%

$166

$2

1.25%

NA

NA

NA

$312

NA

NA

93650

Intracardiac catheter ablation of atrioventricular node function,  atrioventricular conduction for creation of complete heart  block, with or without temporary pacemaker placement

$623

$7

1.16%

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.

$876

$11

1.22%

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

$1,165

$13

1.09%

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

1.02%

NA

NA

NA

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

$1,170

$16

1.40%

NA

NA

NA

93657

Additional linear or focal intracardiac catheter ablation of the  left or right atrium for treatment of atrial fibrillation remaining  after completion of pulmonary vein isolation (add on)

$437

$4

0.93%

NA

NA

NA

$1

0.91%

$149

$1

0.91%

Intracardiac echocardiography during therapeutic/diagnostic  $149 intervention, including imaging supervision and interpretation  (add on) BSC currently has no FDA‐approved ablation catheters for the treatment of atrial fibrillation 93662

26

CRV-278904-AA NOV2014 13 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

Interventional Cardiology Diagnostic Catheterization 93451 26 Right heart catheterization including measurement(s) of oxygen  saturation and cardiac output, when performed 93451 93452 26 Left heart catheterization including intraprocedural injection(s)  for left ventriculography; imaging supervision and  93452 93453 26 Combined right heart cath and left heart catheterization  including intraprocedural injection(s) for left ventriculography,  93453 93454 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93454 93455 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93455 93456 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93456 93457 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93457 93458 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93458 93459 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93459 93460 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93460 93461 26 Catheter placement in coronary artery(s) for coronary  angiography, including intraprocedural injection(s) for coronary  93461

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$149 NA $262 NA $345 NA $263 NA $305 NA $339 NA $379 NA $321 NA $362 NA $403 NA $446 NA

($2) NA ($3) NA ($3) NA ($3) NA ($3) NA ($2) NA ($3) NA ($4) NA ($5) NA ($5) NA ($5) NA

‐1.24% NA ‐1.28% NA ‐0.78% NA ‐1.27% NA ‐0.99% NA ‐0.69% NA ‐0.90% NA ‐1.38% NA ‐1.23% NA ‐1.20% NA ‐1.09% NA

$149 $796 $262 $898 $345 $1,157 $263 $909 $305 $1,058 $339 $1,138 $379 $1,285 $321 $1,089 $362 $1,204 $403 $1,291 $446 $1,477

($2) $6 ($3) $12 ($3) $8 ($3) $6 ($3) $7 ($2) $6 ($3) $6 ($4) $6 ($5) $7 ($5) $8 ($5) $9

‐1.24% 0.76% ‐1.28% 1.31% ‐0.78% 0.72% ‐1.27% 0.61% ‐0.99% 0.62% ‐0.69% 0.51% ‐0.90% 0.44% ‐1.38% 0.53% ‐1.23% 0.57% ‐1.20% 0.61% ‐1.09% 0.60%

93462

Left heart catheterization by transseptal puncture through  intact septum or by transapical puncture (List separately in  addition to code for primary procedure)

$215

$0

0.11%

$215

$0

0.11%

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)

‐7.27%

$101

($8)

‐7.27%

Physiologic exercise study (eg, bicycle or arm ergometry)  including assessing hemodynamic measurements before and 

$89 NA

($10) NA

‐9.87% NA

$89 $278

($10) ($6)

‐9.87% ‐2.20%

93464 93464

26

93531

26

Combined right heart catheterization and retrograde left heart  cath, for congenital cardiac anomalies

$451

($12)

‐2.53%

$451

($12)

‐2.53%

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

$560

$4

0.78%

$560

$4

0.78%

CRV-278904-AA NOV2014 14 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$374

$2

0.61%

$374

$2

0.61%

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)

$48

$4

8.00%

$48

$4

8.00%

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

8.00%

$174

$1

0.77%

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

$5

9.29%

$144

$1

0.95%

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

8.66%

$156

$2

1.10%

$564

$3

0.45%

NA

NA

NA

$0

$0

NA

$0

$0

NA

$670

$2

0.37%

NA

NA

NA

$0

$0

NA

$0

$0

NA

$627

$3

0.51%

NA

NA

NA

93533

26

Combined right heart catheterization and transseptal left heart  cath through existing septal opening, with or w/o retrograde  left heart catheterization, for congenital cardiac anomalies

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

CRV-278904-AA NOV2014 15 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

92929

Abbreviated (Partial) Description

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) 

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$0

$0

NA

$0

$0

NA

$700

$3

0.40%

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

$626

$3

0.46%

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

$702

$3

0.40%

NA

NA

NA

$701

$2

0.35%

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

CRV-278904-AA NOV2014 16 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$0

$0

NA

$0

$0

NA

Percutaneous transluminal coronary thrombectomy mechanical

$183

$1

0.53%

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

10.61%

$100

$10

10.61%

26

Intravascular ultrasound (coronary vessel or graft) during  diagnostic evaluation and/or therapeutic intervention including  imaging supervision, interpretation and report; each additional  vessel (List separately in addition to code for primary  procedure)

$80

$7

9.74%

$80

$7

9.74%

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

10.61%

$100

$10

10.61%

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

9.20%

$80

$7

9.20%

$1,377 $1,420

$7 $5

0.49% 0.32%

NA NA

NA NA

NA NA

$1,123

$10

0.90%

NA

NA

NA

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

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

$1,408

$5

0.35%

NA

NA

NA

33362

Transcatheter aortic valve replacement (tavr/tavi) with  prosthetic valve; open femoral artery approach

$1,539

$4

0.29%

NA

NA

NA

CRV-278904-AA NOV2014 17 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

33363 33364 33365

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

Transcatheter aortic valve replacement (tavr/tavi) with  prosthetic valve; open axillary artery approach Transcatheter aortic valve replacement (tavr/tavi) with  prosthetic valve; open iliac artery approach Transcatheter aortic valve replacement (tavr/tavi) with  prosthetic valve; transaortic approach (e.g., median  sternotomy, mediastinotomy)

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$1,617

$28

1.79%

NA

NA

NA

$1,676

$4

0.26%

NA

NA

NA

$1,845

$2

0.10%

NA

NA

NA

$2,011

$16

0.78%

NA

NA

NA

33366

Transcatheter aortic valve replacement (TAVR/TAVI) with  prosthetic valve; transapical exposure (eg, left thoracotomy)

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)

$647

$3

0.50%

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)

$777

($3)

‐0.43%

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)

$1,026

($4)

‐0.37%

NA

NA

NA

CRV-278904-AA NOV2014 18 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

Peripheral Interventions Non‐Coronary Angioplasty Transluminal balloon angioplasty, percutaneous;  35475 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

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$349

($6)

‐1.77%

$1,590

($20)

‐1.24%

$282

($1)

‐0.19%

$1,454

($15)

‐1.03%

$26 NA $18 NA $65 NA $18 NA $26 NA

($0) NA ($1) NA $1 NA $1 NA ($0) NA

‐1.41% NA ‐3.98% NA 2.19% NA 4.02% NA ‐0.06% NA

$26 $139 $18 $87 $65 $172 $18 $89 $26 $138

($0) ($8) ($1) ($8) $1 ($3) $1 $1 ($0) ($8)

‐1.41% ‐5.41% ‐3.98% ‐8.39% 2.19% ‐1.90% 4.02% 0.75% ‐0.06% ‐5.23%

37220

Revascularization, endovascular, open or percutaneous, iliac  artery, unilateral, initial vessel; with transluminal angioplasty

$435

($0)

‐0.06%

$3,219

($16)

‐0.50%

37221

Revascularization, endovascular, open or percutaneous, iliac  artery, unilateral, initial vessel; with transluminal stent  placement(s), includes angioplasty within same vessel, when  performed

$535

$4

0.82%

$4,749

($1)

‐0.03%

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)

$197

$1

0.31%

$903

($8)

‐0.88%

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

0.26%

$2,646

$8

0.29%

$479

($2)

‐0.43%

$3,907

($12)

‐0.31%

$649

($0)

‐0.06%

$11,242

$52

0.46%

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

CRV-278904-AA NOV2014 19 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final 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

$563

$30

5.58%

$9,244

$56

0.61%

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

$780

($2)

‐0.24%

$15,182

$117

0.78%

$5,556

($13)

‐0.23%

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) ‐0.30% 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

$757

($3)

‐0.34%

$11,089

$69

0.62%

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

$747

$11

1.50%

$8,478

$45

0.53%

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

$812

$5

0.65%

$13,624

$161

1.20%

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)

$213

($0)

‐0.06%

$1,239

$2

0.14%

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)

$346

($2)

‐0.57%

$1,499

$13

0.86%

1.40%

$3,955

$20

0.50%

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)

$299

$4

CRV-278904-AA NOV2014 20 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

37235

37236

37237

37238

37239

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

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)

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

$411

($17)

‐3.99%

$4,246

$229

5.71%

$458

($24)

‐4.96%

$4,211

$1,348

47.10%

$225

($0)

‐0.06%

$2,534

$1,291

103.82%

$333

($4)

‐1.33%

$4,192

$6

0.14%

$167

$10

6.09%

$2,078

($3)

‐0.13%

Catheter Access 36140

Introduction of needle or intracatheter; extremity artery

$107

($0)

‐0.39%

$445

($1)

‐0.22%

36147 36148

Access av dial grft for eval Access av dial grft for proc

$194 $51

($0) ($0)

‐0.06% ‐0.06%

$852 $266

($1) $1

‐0.14% 0.21%

36160

Introduction of needle or intracatheter, aortic, translumbar

$129

($5)

‐3.54%

$504

($15)

‐2.95%

$160

$1

0.39%

$637

$2

0.28%

36200 Introduction of catheter, aorta Catheter Placement 36215

Selective catheter placement, arterial system; each first order  thoracic or brachiocephalic branch, within a vascular family

$246

($6)

‐2.47%

$1,148

$27

2.43%

36216

Selective catheter placement, arterial system; initial second  order thoracic or brachiocephalic branch, within a vascular  family

$285

($3)

‐0.93%

$1,194

($70)

‐5.56%

CRV-278904-AA NOV2014 21 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

36217

Selective catheter placement, arterial system; initial third order  or more selective thoracic or brachiocephalic branch, within a  vascular family

$338

($7)

‐2.13%

$1,930

($243)

‐11.17%

36218

Selective catheter placement, arterial system; additional second  order, third order, and beyond, thoracic or brachiocephalic  branch, within a vascular family (list in addition to code for  initial second or third order vessel as appropriate)

$55

($0)

‐0.06%

$188

($16)

‐7.61%

$263

($3)

‐1.13%

$1,394

$10

0.72%

$280

$0

0.07%

$909

$3

0.30%

36245

36246

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

36247

Selective catheter placement, arterial system; initial third order  or more selective abdominal, pelvic, or lower extremity artery  branch, within a vascular family

$332

($3)

‐0.92%

$1,607

($1)

‐0.04%

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

$51

($2)

‐4.08%

$155

($1)

‐0.75%

$1,136

$9

0.77%

NA

NA

NA

NA

NA

NA

Carotid Artery Stenting 37215

Transcatheter placement of intravascular stent(s), cervical  carotid artery, percutaneous; with distal embolic protection

37216

Transcatheter placement of intravascular stent(s), cervical  carotid artery, percutaneous; without distal embolic protection

$0

($1,050) ‐100.00%

Vena Cava Filters 37191

Insertion of inferior vena cava filter, endovascular approach  including vascular access, vessel selection and radiological  supervision and interpretation (including ultrasound) when  performed.

$250

$0

0.08%

$2,686

$3

0.10%

37192

Repositioning of inferior vena cava filter, endovascular  approach including vascular access, vessel selection and  radiological supervision and interpretation (including  ultrasound) when performed.

$391

$14

3.84%

$1,713

$158

10.19%

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

($2)

‐0.62%

$1,634

($4)

‐0.23%

CRV-278904-AA NOV2014 22 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

Thrombectomy 36870

Thrombectomy, percutaneous, arteriovenous fistula,  autogenous or nonautogenous graft (includes mechanical  thrombus extraction and intra‐graft thrombolysis)

$313

($0)

‐0.06%

$1,868

$2

0.11%

37184

Primary percutaneous transluminal mechanical thrombectomy,  noncoronary, arterial or arterial bypass graft, including  fluoroscopic guidance and intraprocedural pharmacological  thrombolytic injection(s); initial vessel

$482

$9

1.83%

$2,319

$24

1.05%

37185

Primary percutaneous transluminal mechanical thrombectomy,  noncoronary, 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

$175

$1

0.76%

$734

($3)

‐0.35%

37186

Secondary percutaneous transluminal thrombectomy (eg,  nonprimary mechanical, snare basket, suction technique),  noncoronary, 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)

$261

($3)

‐1.01%

$1,406

($6)

‐0.44%

37187

Percutaneous transluminal mechanical thrombectomy, vein(s),  including intraprocedural pharmacological thrombolytic  injections and fluoroscopic guidance

$426

$4

0.87%

$2,106

$4

0.18%

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

$307

$4

1.24%

$1,798

($13)

‐0.71%

34101

Thrombectomy, with or without catheter; axillary, brachial,  innominate, subclavian artery, by arm incision

$634

($2)

‐0.29%

NA

NA

NA

$630

($5)

‐0.74%

NA

NA

NA

$1,087

($6)

‐0.58%

NA

NA

NA

34111 34201

Thrombectomy, with or without catheter; radial or ulnar artery,  by arm incision Thrombectomy, with or without catheter; femoral\popliteal,  aortoiliac artery, by leg incision

CRV-278904-AA NOV2014 23 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

Thrombectomy, with or without catheter; axillary and  subclavian vein, by arm incision

$642

$3

0.44%

NA

NA

NA

37211

Transcatheter therapy, arterial infusion for thrombolysis other  than coronary, any method, including radiological supervision  and interpretation, initial treatment day

$417

($2)

‐0.40%

NA

NA

NA

37212

Transcatheter therapy, venous infusion for thrombolysis, any  method, including radiological supervision and interpretation,  initial treatment day

$366

($4)

‐1.03%

NA

NA

NA

37213

Transcatheter therapy, arterial or venous infusion for  thrombolysis other than coronary, any method, including  radiological supervision and interpretation, continued  treatment on subsequent day during course of thrombolytic  therapy, including follow‐up catheter contrast injection,  position change, or exchange, when performed

$258

$1

0.22%

NA

NA

NA

37214

Transcatheter therapy, arterial or venous infusion for  thrombolysis other than coronary, any method, including  radiological supervision and interpretation, continued  treatment on subsequent day during course of thrombolytic  therapy, including follow‐up catheter contrast injection,  position change, or exchange, when performed; cessation of  thrombolysis including removal of catheter and vessel closure  by any method

$142

($10)

‐6.41%

NA

NA

NA

$112

($0)

‐0.06%

NA

NA

NA

$83

($0)

‐0.49%

NA

NA

NA

34490

Thrombolysis

Non‐Coronary IVUS Intravascular ultrasound (non‐coronary vessel) during diagnostic  evaluation and/or therapeutic intervention; initial vessel (List  separately in addition to code for primary procedure)

37250

Intravascular ultrasound (non‐coronary vessel) during diagnostic  evaluation and/or therapeutic intervention; each additional  37251 vessel (List separately in addition to code for primary  procedure) Radiological S&I (Non‐Cor IVUS) 75945

26

Intravascular ultrasound (peripheral vessel) radiological  supervision and interpretation; initial vessel

$20

$0

1.72%

$20

$0

1.72%

75946

26

each additional non‐coronary vessel (List separately in addition  to code for primary procedure)

$20

($0)

‐0.06%

$20

($0)

‐0.06%

Angiograms 75710 26 75710

Angiography, extremity, unilateral, radiological supervision and  interpretation

$55 NA

($0) NA

‐0.06% NA

$55 $162

($0) ($15)

‐0.06% ‐8.37%

CRV-278904-AA NOV2014 24 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

75716 75716 75726 75726

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

26 26

Abbreviated (Partial) Description

Angiography, extremity, bilateral, radiological supervision and  interpretation Angiography, visceral, selective or supraselective (with or  without flush aortogram), radiological supervision and 

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $ $66 NA $57 NA

$ $1 NA $0 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

% 1.60% NA 0.57% NA

$ $66 $188 $57 $151

$ $1 ($23) $0 ($14)

% 1.60% ‐11.07% 0.57% ‐8.73%

0.56% NA 0.50% NA 7.73% NA

$58 $172 $65 $184 $59 $164

$0 ($11) $0 ($21) $4 ($10)

0.56% ‐6.12% 0.50% ‐10.02% 7.73% ‐5.62%

Bronchosopy; with placement of tracheal stent(s) (inludes  tracheal/bronchial dilation as required)

$238

$1

0.24%

NA

NA

NA

Biliary endoscopy, percutaneous via T‐Tube or other tract; with  dilation of biliary duct stricture(s) with stent

$437

($1)

‐0.14%

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)

‐0.85%

$45

($0)

‐0.85%

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)

$872

($3)

‐0.31%

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)

$412

$0

0.03%

$6,021

$65

1.09%

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

$463

($1)

‐0.21%

$4,681

$47

1.01%

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 

$517

($1)

‐0.20%

$7,891

$86

1.10%

31631 Biliary Stenting 47556

Embolization

CRV-278904-AA NOV2014 25 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association

CPT®

Modifier

Note: Rates effective through March 31, 2015 then subject to change via 21.2% SGR reduction expected to be addressed by Congress for April

Abbreviated (Partial) Description

2015 Final  2015 Final  Variance 2015 Final  Variance 2015  In‐Facility  In‐Office  vs. 2014 Final Final vs. 2014 Final Rate Rate $

$

%

$

$

%

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%

$9,961

$108

1.09%

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

$719

($2)

‐0.26%

$6,970

$71

1.03%

$488

$1

0.23%

NA

NA

NA

Drainage 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 

$598

($0)

‐0.06%

NA

NA

NA

$88 $364

$0 $2

0.35% 0.53%

$530 $1,403

$9 $9

1.66% 0.63%

$238

$3

1.31%

NA

NA

NA

$185

$0

0.13%

NA

NA

NA

Exchange of previously placed abscess or cyst drainage catheter  under radiological guidance (separate procedure)

$76

$1

0.90%

$560

$4

0.78%

26

Percutaneous transhepatic biliary drainage with contrast  monitoring, radiological supervision and interpretation

$74

$1

1.90%

$74

$1

1.90%

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

$74

$1

1.42%

$74

$1

1.42%

75984

26

Change of percutaneous tube or drainage catheter with  contrast monitoring (eg, genitourinary system, abscess),  radiological supervision and interpretation

$36

($0)

‐0.06%

$36

($0)

‐0.06%

47510 47511 47525 47530 49421 50392 49423

75980

CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS  Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part  of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no  liability for data contained or not contained herein.   • Please note: this coding information may include some codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those  instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of  any Boston Scientific products for which they are not cleared or approved.  • National average final base payment amounts.  Specific payment rates may change due to geographic wage differences. • Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within  this guide are commonly used codes and are not intended to be an all‐inclusive list. We recommend consulting your relevant manuals for appropriate coding options.

CRV-278904-AA NOV2014 26 of 26 See page 4 for important information about the uses and limitations of this document. CPT Copyright 2014 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association