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CARDIAC DEVICE MONITORING(EVALUATIONS)

MEDTRONIC CARDIAC RHYTHM AND HEART FAILURE (CRHF)

CRHF Economics & Health PolicyFebruary 15, 2017

DISCLAIMER This presentation is intended only for educational use. Any duplication is prohibited without

written consent of the authors. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures.

Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.

CPT copyright 2016 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 the data contained or not contained herein.

Note: CPT® code descriptions may be abbreviated and not listed in their entirety in all cases in this presentation. For full descriptions, please refer to your 2017 CPT code book.

2 CRHF ECONOMICS & HEALTH POLICY

CONTINUING EDUCATION UNITS

This program has prior approval of the American Academy ofProfessional Coders (AAPC) for one continuing education hour. Granting of this prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

The AAPC requires attendees to participate in the entire Web-Ex presentation in order to qualify for the CEU certificate.

Registered attendees that qualify will receive an email that includes the AAPC CEU certificate within a couple of weeks.


AGENDA

Cardiac Device Evaluation Background

Medicare Guidelines, National and Local MACs

Provider-Based Designations or Office Based

Cardiac Device Monitoring Medicare National Payment Rates

Medicare Requirements: Diagnostic Tests and Supervision

Cardiac Device Coding Examples

Appendix

Q&A


Cardiac Device Evaluation Background


CARDIAC DEVICE MONITORING DEFINITIONS PER THE AMA


Programming Device Evaluation – In Person

Iterative adjustments made to parameters and evaluated.

Final parameters may be same as original

Always includes interrogation and (temporary) reprogramming

Remote Monitoring

Defined time periods: 30 day monitoring period, do not report if monitoring period is less than 10 days.90 day monitoring period, do not report if monitoring period is less than 30.

Monitoring period starts with the first monitoring service, continues through 30 or 90 days

New time period begins on the 31st or 91st day*

* Contact your MAC/payer for additional information.

CALCULATION OF MONITORING DAYSPAYERS VARY ON HOW DAYS ARE CALCULATED Calendar Day Method (30 days) 30 days is calculated to include the day

the monitoring starts through the last (30th) day of the reported episode.

Simple Math Method (31 days) 30 days is calculated by adding the 30

days to the start date (January 2nd + 30 days = February 1st)

The date of service (DOS) will be the date that either the technical or professional service is performed (each practice may determine which date to use). Note that the DOS reported will drive the next monitoring episode, since some payers use the date following that DOS as the next episode start date.


TECHNICAL COMPONENT AND PROFESSIONAL COMPONENT DEFINITIONS PER MEDICARE

The Technical Component (TC) of a service: All non-physician work, includes administrative, personnel and capital (equipment and facility) costs, and related malpractice expenses.1

For remote services, the Technical Component includes remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results2

The Professional Component (PC) of a service:Physician’s work interpreting a diagnostic test or performing a procedure, and includes indirect practice and malpractice expenses related to that work.1

When there are two separate procedure codes for the professional and technical components of the device monitoring a TC/26 modifier would not be appended.2

1 Medicare Learning Network® ICN907164/June 2013: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Radiology_FactSheet_ICN907164.pdf2 AMA 2017 CPT code book


Medicare Guidelines, National and Local MACs


CARDIAC PACEMAKER EVALUATION SERVICES NCD §20.8.1 AND 20.8.1.1 OF CMS PUB. 100-03 (NATIONAL)

The decision as to how often any patient's pacemaker should be monitored is the responsibility of the patient's physician who is best able to take into account the condition and circumstances of the individual patient.

Transtelephonic monitoring (TTM) Guidelines I and II are for both single and dual chamber pacemakers. The TTM guidelines are in this NCD.

Pacemaker clinic* service frequency guidelines for routine monitoring are:– Single chamber: Twice in the first 6 months following implant, then once every 12

months

– Dual chamber: Twice in the first 6 months following implant, then once every 6 months

Increased frequency of monitoring must be supported by documented medical necessity.

* Please note that “Pacemaker clinic” also includes “Physician practice, Place of Service (POS)” and “Hospital device monitoring departments”.Rev. 182, 05-22-15 is available at:http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part1.pdf


OTHER CRHF IMPLANTABLE DEVICES

Medicare (CMS) has not issued any national device monitoring frequency guidelines for other implantable devices such as defibrillators and implantable loop recorders.

Consider requesting guidance from the applicable specialty society where your Physicians are members.


PACEMAKER/DEFIBRILLATOR DEVICE EVALUATION GUIDANCE SUMMARYGuidance Single Chamber

PacemakersDual/CRT-P Chamber

PacemakersSingle/Dual/CRT-D Chamber

Defibrillators

CMS Device Evaluation Services – Routine/ Asymptomatic

1 device evaluation per year

(POS not Specified)

1 device evaluation every six months

(POS not Specified)

No Guidance

Novitas Local Coverage Determination1

Routine/Asymptomatic CMS guidelines included.Symptomatic patients: type (remote/in person) of

monitoring is combined and will be considered when evaluating frequency reasonableness for

medical necessity.

Routine/Asymptomatic: 4 device evaluations per year

Symptomatic patients: more frequent monitoring if medically necessary.

CGS Local Coverage Determination2

N/A Symptomatic patients: frequency and the need for both face-to-face and remote

monitoring services should be coordinated to eliminate unnecessary

duplication. NGS Local Coverage Article3

CPT CodeGuidance4

In office: programming device evaluations include all interrogation device evaluation services.Remote monitoring: no more than once every 90 days

Heart Rhythm Society5 In office: Once per year Remote PMs: Every 3-12 months

In office: Once per year Remote ICDs: Every 3-6 months

1 Novitas Solutions Inc. Local Coverage Determination: Cardiac Rhythm Device Evaluation L34833 effective 10.1.20152 CGS , Web, or Non-Web Based L34087 effective 10.1.2015.3 National Government Services . Local Coverage Article: Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based – Medical Policy Article A53018 effective October 1, 2015.4 2017 American Medical Association CPT® codes.5 2015 HRS Expert Consensus Statement on Remote Interrogation and Monitoring for Cardiovascular Electronic Implantable Devices page 32, 2008 HRS/EHRA Expert Consensus on the Monitoring and Cardiovascular Implantable Electronic Devices (CIED) and 2012 ACCF/AHA/HRS Focused Update


Provider-Based Designations or Office Based


PROVIDER-BASED PHYSICIAN PRACTICE “SPLIT BILLING”

A Practice designated as office based reports Place of Service (POS) 11 Office on the professional claim form, and is paid based on the Medicare Physician Fee Schedule (MPFS).

Provider-Based: Off-Campus or On-Campus POS for claim submission1 :

POS 19: Off-Campus Outpatient Hospital

POS 22: On-Campus Outpatient Hospital

In 2017 POS 19 (Off-Campus) sites will be paid differently:– Off-Campus Provider-Based Departments (PBD) existing and furnishing services as

of November 2, 2015 will receive payment for the hospital portion of the facility claim based on OPPS and the payment for the physician portion (professional claim) payment will based on the MPFS. This is commonly referred to as “Split Billing.”

– Off-campus PBDs certified after November 2, 2015, or existing PBDs who had a change in location after that date, will be subject to an alternative payment mechanism, as defined in an interim rule in the CY 2017 OPPS Final Rule.

Source: CY 2017 OPPS: Page 79699-79718 of the Federal Register dated November 14, 2016. Corrections of the final rule were included in the Federal Register dated January 3, 2017. See Appendix for the link.


HOSPITALS: PROVIDER-BASED

Non-Excepted: Medicare classification for Off-campus Provider-based services.An Off-campus Provider-based department is still considered a department of the hospital and will be included in the Hospital’s Medicare cost report with this type of designation.

CY 2017 OPPS Final Rule: CMS determined that the Medicare payment source for “Non-Excepted” Off-campus departments should be based on the Medicare Physician Fee Schedule (MPFS), and also stated it is impossible to create a payment structure and claims processing rules in time for a CY 2017 implementation date.

The final rule provided an “interim rule” with a comment period that was corrected to end on January 3, 2017 instead of December 31, 2016. CMS plans to review these comments and this may result in changes. As of today, CMS has not released their comments.

Excepted: On Campus Provider-based departments or those Off-Campus that were certified by CMS before November 2, 2015.This means the technical component for services provided in these provider-based departments will continue to be paid under OPPS.

Source: CY 2017 OPPS: Page 79699-79718 of the Federal Register dated November 14, 2016. Corrections of the final rule were included in the Federal Register dated January 3, 2017. See Appendix for the link.


HOSPITAL OFF-CAMPUS MODIFIERS: PO AND PN

PO Modifier implemented January 1, 2016: Used to designate Services, procedures and/or surgeries furnished at off-campus, provider-based outpatient departments

– PO designated services are Excepted.

– Required to be reported with every code (service) that is provided at an off-campus Provider-Based Department (PBD).

– Not required for remote locations of a hospital and satellite facilities.

PN Modifier implemented January 1, 2017:

– PN designated services as Non-Excepted.

– Not payable under OPPS and this modifier will trigger applicable payment.

– This payment represents the technical component of Physician services and will be adjusted by the hospital wage index.

– For CY 2017, assume to be 50% of OPPS payment.

1 PO modifier information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9097.pdfPO modifier FAQ dated January 19, 2016: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf

CY 2017 OPPS: Page 79699-79718 of the Federal Register dated November 14, 2016. See Appendix for the link.


PROVIDER-BASED OFF-CAMPUS DEPARTMENT BILLING

PB prior to11/02/2015CY 2017 Payments

Use modifier PO for off-campus

PB on or after 11/02/2015CY 2017 Payments

Use modifier PN for off-campusClaimsSplit-billed

Professional Claim:Place of service OP Hospital POS 19 for off-campus (1/01/2016)

Hospital Claim:Outpatient hospital claim with POmodifier for technical fee

Professional Claim:Place of service OP Hospital POS 19 for off-campus (1/01/2016)

Hospital Claim:Outpatient hospital claim with PNmodifier for technical fee

Payment Technical fee: APC (Hospital)

Pro fee: Physician fee schedule at facility rate

Technical fee: APC (Hospital) at approx. 50% rate

Pro fee: Physician fee schedule at facility rate

Example93283 - Dual lead ICD in person programming

APC*: $341

Pro Fee: $582

Total: $92(Same reimbursement for On-Campus)

APC*: $171 (at 50% rate)Per interim rule

Pro Fee: $582

Total: $75

CY 2017 OPPS: Page 79699-79718 of the Federal Register dated November 14, 2016. See Appendix for the link.Physician Global: PC (Professional Component) plus TC (Technical Component)*Hospital APC: Ambulatory Payment Classification1 Hospital payment rate: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html2 Physician payment rate: http://www.cms.gov/apps/physician-fee-schedule/overview.aspx


Cardiac Device MonitoringMedicare National Payment Rates


CPT code and a brief description Global Professional

Pacemakers – In Person

93279 Programming single lead system $49.94 $32.36

93280 Programming dual lead system $58.03 $38.34

93281 Programming multiple lead system $68.23 $45.02

93288 Interrogation single, dual or multiple lead system $37.28 $21.45

Transtelephonic Monitoring (TTM)

93293 Pacemaker TTM up to 90 days $53.46 $15.83

Remote Pacemaker Services Professional Technical

93294 Remote interrogation up to 90 days $33.76 NA

93296 Remote interrogation up to 90 days NA $26.03

1 CY 2017 Physician fee schedule relative value files are at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.htmlModifier -26: Professional Component See Appendix for CPT code descriptions.

2017 PHYSICIAN NATIONAL MEDICARE PAYMENT RATES1

AFTER 2% SEQUESTRATION - CARDIAC DEVICE MONITORING



Defibrillators – In Person

93282 Programming single lead system $62.96 $42.56

93283 Programming dual lead system $81.24 $57.68

93284 Programming multiple lead system $90.04 $62.96

93289 Interrogation single, dual or multiple lead system

Remote Defibrillator Services Professional Technical


93296 Remote interrogation up to 90 days NA $26.03






Implantable Loop Recorder (ILR) – In Person

93285 Programming $41.85 $26.03

93291 Interrogation $36.58 $21.81

Remote ILR Services Professional Technical


93299 Remote interrogation up to 30 days NA ContractorPriced






Implantable Cardiovascular Monitor (ICM) – In Person (physiologic data elements)

93290 Interrogation $31.30 $21.81

Remote ICM Services Professional Technical


93299 Remote interrogation up to 30 days NA Contractor Priced






2017 OP HOSPITAL NATIONAL MEDICARE PAYMENT RATES1


CPT code Assigned Outpatient APC

Medicare National PaymentAdjusted by 2% Sequestration

Pacemakers

93279-93281, 93288, 93293, 93296

5741 $34.45

ICDs

93282-93284, 93289, 93296 5741 $34.45

Implantable Cardiovascular Monitor (ICM)

93290, 93299 5741 $34.45

Implantable Loop Recorder (ILR)

93285, 93299 5741 $34.45

93291 5732 $27.81

1 Corrected Calendar Year 2017 Hospital APC payments are available at:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.htmlSee Addendix for CPT code descriptions.

Medicare Requirements: Diagnostic Tests and Supervision


MEDICARE GLOBAL SURGICAL PERIOD1

Each surgical CPT code has a surgical period associated with the service 90 days: Major surgical procedures, includes all CRHF implants 10 days: Minor surgical procedures Some procedures have zero global days

Major surgical procedures and the 90 day global surgical period: Bundled: preoperative visits after the decision is made to operate (includes

1 day before procedure), and 90 days post-implant

Included: Routine follow-up (e.g., post-op visits), wound checks

Not included in the Global Surgery Period (may be paid separately): Initial consultation/evaluation by the surgeon to determine need for major

surgery Visits unrelated to the diagnosis for which the surgical procedure is

performed, unless the visits occur due to complication of the surgery. Diagnostic tests/procedures, including diagnostic radiological procedures.

Device monitoring procedures are diagnostic procedures

1 Publication 100-04 Medicare Claims Processing Manual, Chapter 12 Physician/NonPhysician Practitioners is available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf


DEVICE MONITORING REQUIREMENTSDEVICE MONITORING SERVICES ARE DIAGNOSTIC TESTS

A written order is needed Coding rules must be followed

Diagnosis coding should reflect the reason for the monitoring; Is it medical necessity or routine monitoring?

Documentation: The provider report should support medical necessity and include findings and a patient care plan

Coverage rules must be understood and followed CMS has a pacemaker monitoring NCD that affects frequency

Some Medicare contractors have local polices for defibrillator and bi-ventricular defibrillators

Carefully check commercial payer coverage for billing and frequency guidelines

Supervision requirements for diagnostic testing must be met These differ from incident-to guidelines used for office visits


DIAGNOSTIC TESTS:MEDICARE ORDER REQUIREMENTS1,2

Diagnostic tests must be ordered by the physician/practitioner treatingthe patient and who uses the results to treat the patient. (Diagnostic tests ordered by a non-treating physician/practitioner are considered not

reasonable and necessary)

What is an order? Communication from the treating physician/practitioner requesting that a

diagnostic test be performed for the Medicare beneficiary

When a physician/practitioner’s order for a diagnostic test does not require a signature, the physician/practitioner must clearly document, in the medical records, his or her intent that the test be performed.

How may an order be delivered? An order may be delivered via signed written document, a telephone call, or via email

1 Title 42 Code of Federal Regulations Part 414-Payment for Part B Medical and Other Health Services (Subpart B):http://www.ecfr.gov/cgi-bin/text-idx?SID=c046900b4d8394fad36b02417227da74&mc=true&node=sp42.3.414.b&rgn=div62 Publication 100-04 Medicare Claims Processing Manual, Chapter 23 Fee Schedule Administration and Coding Requirements, §10.1.2: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c23.pdf


KEY DOCUMENTATION FOR MEDICAL NECESSITY

In Person Programming: Each parameter tested and the result should be maintained in the record.

All Device Evaluations: Relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Coding: CPT/HCPCS codes should describe the service performed. The medical record must support the ICD-10 diagnosis codes.


MEDICARE SUPERVISION REQUIREMENTS TECHNICAL COMPONENT OF DIAGNOSTIC TESTS

GENERAL SUPERVISION

Applies to the technical component for all remote interrogation services. The procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the nonphysician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Medicare supervision requirements for specific procedure codes: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.htmlClick on PFS Relative Value Files, then Calendar Year 2017 to obtain the most updated file.

Medicare Benefit Policy Manual, CMS-Pub. 100-02 Chapter 15, Section 80-Covered Medical and Other Health Services: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf


MEDICARE SUPERVISION REQUIREMENTS TECHNICAL COMPONENT OF DIAGNOSTIC TESTS

Applies to the technical component for all in person cardiac device interrogations/evaluations. A physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.

DIRECT SUPERVISION

In a hospital (facility) setting, direct supervision means that the physician must be immediatelyavailable to furnish assistance and direction throughout the performance of the procedure.

BILLING

Under diagnostic testing rules, the physician supervising the in person device monitoring is not required to bill for the service. The physician who reads the professional report may bill for the test (global for office and professional component for facility services). This is different than the billing rules for services that are performed incident-to a physician, such as office visits.

Medicare supervision requirements for specific procedure codes: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.htmlClick on PFS Relative Value Files, then Calendar Year 2017 to obtain the most updated file.

Medicare Benefit Policy Manual, CMS-Pub. 100-02 Chapter 15, Section 80-Covered Medical and Other Health Services: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf


Cardiac Device Coding Examples


ICD-10 DEVICE MONITORING DIAGNOSIS CODES

Scheduled (Routine) Device Monitoring

ICD-10-CM Diagnosis Code

Pacemaker

Z95.0

Presence of cardiac pacemaker

Defibrillator

Z95.810

Presence of automatic (implantable) cardiac defibrillator

Other Devices: For example - Implantable Loop Recorder (ILR)

Z95.818

Presence of other cardiac implants and grafts


ICD-10 DEVICE MONITORING DIAGNOSIS CODES

Device Monitoring for Patients without a Codeable Complaint or a SymptomExample: Device near ERI


Pacemaker

Z45.010

Encounter for checking and testing of cardiac pacemaker pulse generator [battery]

Z45.018

Encounter for adjustment and management of other part of cardiac pacemaker

Implantable Defibrillator

Z45.02

Encounter for adjustment and management of automatic implantable cardiac defibrillator

Other Devices: For example - Implantable Loop Recorder (ILR)

Z45.09

Encounter for adjustment and management of other cardiac device


EXAMPLES OF ICD-10 COMPLAINT/SYMPTOM DIAGNOSIS CODES


I49.9: Cardiac arrhythmia, unspecified

R55: Syncope and Collapse

R42: Dizziness

R00.2: Palpitations

Remember to review Medicare Local Coverage Determinations/Articles, contact your Medicare Administrative Contractor (MAC), or refer to your private payer policies.


COINSURANCE EXAMPLE FOR ICM/ILR REMOTE MONITORING* NATIONAL PAYMENT RATES INCLUDE 2% SEQUESTRATION ADJUSTMENT

Remote Monitoring

Description Code2017

Payment*1,22017 Patient

Responsibility**

ICM Professional

Professional Analysis any # of leadsUp to 30 days 93297 $26 $5

ILR Professional

Interrogation device evaluation(s), (remote) up to 30 days, professional

93298 $27 $5

ICM/ILR Technical (in office) Interrogation device evaluation(s), (remote)

up to 30 days, technical93299

Contractor priced:

$11-$273$2-$55

ICM/ILR Technical (Facility)

$34 $7

** Outpatient Hospital (Facility) and physician services are subject to a 20% coinsurance. Payment amount reflects Medicare and patient responsibility.1. CY 2017 Medicare physician payments are available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

2. CY 2017 Hospital C-APC payments are available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html


CY 2017 PHYSICIAN NATIONAL PAYMENT AMOUNTS AFTER 2% SEQUESTRATION PACEMAKER CARDIAC DEVICE MONITORING

G: GlobalTC: Technical ComponentPC: Professional Component

The National Medicare Pacemaker Follow-upGuidelines released in 1984 are still in effect.

CY 2017 Medicare National Payment rates are at: http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

Pacemaker

One codeany # of leads per encounter

Professional Analysis

any # of leadsUp to 90 days

Technical Support


Transtelephonicone code


MultipleLead

SingleLead

DualLead

In Person Remote

Interrogation Peri-Proceduralin person onlyany # of leads

G: $50TC: $18PC: $32

G: $58TC: $20PC: $38

G: $68TC: $23PC: $45

G: $37TC: $16PC: $21

G: $53TC: $37PC: $16

TC: $26

G: $27TC: $12PC: $15

PC: $34

93286

93279 93280 93281

93288 93294 93296 93293

Programming evaluationper encounter


CARDIAC RHYTHM AND HEART FAILURE (CRHF) INFORMATIONCARDIAC RHYTHM AND HEART FAILURE (CRHF) RESOURCES

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IMPLANT AND MONITORING FAQS



MEDTRONIC CRHF CUSTOMER DOCUMENTS

APPENDIX


2017 PHYSICIAN NATIONAL PAYMENT AMOUNTS AFTER 2% SEQUESTRATION ICD CARDIAC DEVICE MONITORING

G: GlobalTC: Technical ComponentPC: Professional Component ICD

MultipleLead

SingleLead

DualLead

In Person Remote

Interrogation Peri-Proceduralin person onlyany # of leads

G: $63TC: $20PC: $43

G: $81TC: $23PC: $58

G: $90TC: $27PC: $63

G: $36TC: $13PC: $23

93287

93282 93283 93284



Technical Support


93289

One codeany # of leads per encounter

93295 93296

G: $65TC: $19PC: $46

TC: $26PC: $68




CY 2017 PHYSICIAN NATIONAL PAYMENT AMOUNTS AFTER 2% SEQUESTRATION ICM CARDIAC DEVICE MONITORING



Implantable Cardiovascular Monitor (ICM)

In Person

RemoteInterrogation



Technical Support


93290

One codeany # of leads Per encounter

93297

93299

G: $31TC: $9PC: $22

Contractor Priced

PC: $26

ICD

MultipleLead

SingleLead

DualLead

In Person

Interrogation

Peri-Proceduralin person onlyany # of leads

G: $63TC: $20PC: $43

G: $81TC: $23PC: $58

G: $90TC: $27PC: $63

G: $36TC: $13PC: $23

93287

93282 93283 93284

93289

One codeany # of leads Per encounter

G: $65TC: $19PC: $46


Remote



Technical Support


93295

93296

TC: $26

PC: $68


CY 2017 PHYSICIAN NATIONAL PAYMENT AMOUNTS AFTER 2% SEQUESTRATION ICM CARDIAC DEVICE MONITORING


Implantable Cardiovascular Monitor

(ICM)

In Personper encounterInterrogation



Technical Support


93297 93299

PC: $26 Contractor Priced

Remote

+

G: $31TC: $9PC: $22

93290



CY 2017 PHYSICIAN NATIONAL PAYMENT AMOUNTS AFTER 2% SEQUESTRATION ILR CARDIAC DEVICE MONITORING


Implantable Loop Recorder (ILR)



Technical Support


93298 93299

PC: $27 Contractor Priced

+

Interrogation

Remote


G: $42TC: $16PC: $26

93285

G: $37TC: $15PC: $22

In Personper encounter

93291



INCIDENT-TO BILLING

“Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.1

– To qualify as “incident to,” services must be part the patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment.

– A supervising Physician/Practitioner must be present in the suite (direct supervision).

– The advantage to the incident-to rule is that a service performed by an NPP (such as a NP or PA) may be billed under the supervising physician’s provider number, which means that the service will be paid at the physician rate by Medicare.

– If there is no supervising physician, the service must be billed with the NPP’s provider number and paid at 85% of the physician rate.

The Physician/Practitioner who bills must be the supervising physician/practitioner.

Services provided by non-physician practitioners (NPPs) must be compliant with State laws and State supervision requirements.

1 https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se0441.pdf

Pages 71065-71068 of Federal Register dated November 16, 2015.


MAC LOCAL PACEMAKER DEVICE IMPLANT POLICIES1

State MAC (Medicare Administrative Contractor)

Number

AL, GA, TN Cahaba GBA A54949

KY, OH Cigna Government Services (CGS) A54961

FL, PR, VI First Coast Service Options (FCSO) A54926

CT, IL, MA, ME, MN, NH, NY, RI, VT, WI

National Government Services (NGS) A54909

CA, HI, NV Noridian A54929

AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY

Noridian A54931

AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX

Novitas L34833

NC, SC, VA, WV Palmetto GBA A54831

IA, IN, KS, MI, MO, NE Wisconsin Physician Services (WPS) A54958

1 CMS website: https://www.cms.gov/medicare-coverage-database/search/advanced-search.aspx


DEVICE MONITORING

2017 CPT code book

CPT®

Code Description

93279Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system

93280Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system

93281Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system

93282Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system

93283Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system

93284Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system

93285Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system


DEVICE MONITORING - CONTINUED

CPT®

Code Description

93286Peri-procedural device evaluation (in person) and programming of device system parameters before or aftera surgery, procedure, or test with analysis, review and report by a physician or other qualified health careprofessional; single, dual, or multiple lead pacemaker system

93287Peri-procedural device evaluation (in person) and programming of device system parameters before orafter a surgery, procedure, or test with analysis, review and report by a physician or other qualified healthcare professional; single, dual, or multiple lead implantable defibrillator system

93288Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system

93289

Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements

93290

Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors

93291Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis

2017 CPT code book


CPT®

Code Description

93293Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days

93294Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

93295Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

93296Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

93297Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system,including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal andexternal sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional

93298Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional

93299Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

2017 CPT code book

DEVICE MONITORING - CONTINUED


APPENDIX: REFERENCES

OPPS Calendar Year 2017:OPPS CY 2017 Federal Register dated November 14, 2016 and Corrections in the January 3, 2017 Federal Register are both available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html

Data files released with the CY 2017 final rule are available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.htmlClick on Hospital Outpatient Regulations and Notices, then Regulation No. CMS-1656-FC. The “2017 Final Rule OPPS Addenda” zip file includes: Addendum A (APC payment), Addendum B (HCPCS listing and APC assignment), Addendum C (APC assignment and every HCPCS assigned to that APC), Addendum D-1 (Status Indicators), Addendum J (Complexity Adjusted APC details) and other files.

Press Release:CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Carehttps://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-11-01.html

Fact Sheet:CMS Finalizes Hospital Outpatient Prospective Payment Changes for 2017https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-01-3.html

MPFS Calendar Year 2017:MPFS CY 2017 Federal Register dated November 15, 2016 and Corrections in the December 29, 2016 Federal Register are bothavailable at:https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html

The 2017 Relative Value file is available by clicking on “PFS Relative Value Files” at:https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html


APPENDIX: REFERENCES

Definitions of Remote locations and Satellite locations: Page 66913 of the November 10, 2014 Federal Register publicationof the CY 2015 Final Rule. This file is available at: https://www.gpo.gov/fdsys/pkg/FR-2014-11-10/pdf/2014-26146.pdf

Remote locations of a hospital:hospital campus other than the main hospital campus; facility or an organization that is either created by, or acquired by, a hospital that is a main provider for the purpose of furnishing Inpatient hospital services under the name, ownership, and financial and administrative control of the main provider.

Satellite locations of a hospital: provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital


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