Dialysis Vascular AccessCoverage, Coding and Reimbursement Overview — Hospital Outpatient 2019 Edition — All Reimbursement Amounts are Listed at National Unadjusted Medicare Rates and Do Not Include the 2% Sequestration Reduction

Hospital Outpatient rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA APC SIB RateC

Graft, vascular C1768 ---- N ----C1874 ---- N ----

CREATIONA

Insertion of cannula for hemodialysis, other purpose (separate procedure); 36818 5184 J1 $4,377arteriovenous, external revision, or closure

by upper arm cephalic vein transposition 36819 5184 J1 $4,377

by forearm vein transposition 36820 5184 J1 $4,377

direct, any site (eg, Cimino type) (separate procedure) 36821 5183 J1 $2,642

Creation of arteriovenous fistula by other than direct arteriovenous 36825 5184 J1 $4,377anastomosis (separate procedure); autogenous graft

nonautogenous graft (eg, biological collagen, thermoplastic graft) 36830 5184 J1 $4,377ImagingInjection procedure for extremity venography (including introduction of 36005 ---- N ----needle or intracatheter)

Venography, extremity, unilateral, radiological supervision and interpretation 75820 5181 Q2 $620

Venography, extremity, bilateral, radiological supervision and interpretation 75822 5182 Q2 $1,094

Duplex scan of extremity veins including responses to compression and other 93971 5522 S $113maneuvers; unilateral or limited studyMAINTENANCEA

Thrombectomy, open, arteriovenous fistula without revision, autogenous or 36831 5184 J1 $4,377nonautogenous dialysis graft (separate procedure)

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Status Indicators: J1-Hospital Part B Services Paid Through a Comprehensive APC; N-ltems and Services Packaged into APC Rates; Q2-T-Packaged Codes; S-Procedure or Service, Not Discounted When Multiple. C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-CN2, Centers for Medicare and Medicaid Services.

*Per CMS-1695-FC, device-intensive procedures require the reporting of a device HCPCS code. Device code reporting requirements apply.

Procedure

REIMBURSEMENTB

Device Code*

Stent, coated/covered, with delivery system

HOSPITAL OUTPATIENT REVIEW

Hospital Outpatient rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA APC SIB RateC

MAINTENANCEA

Revision, open, arteriovenous fistula; without thrombectomy, autogenous or 36832 5184 J1 $4,377nonautogenous dialysis graft (separate procedure)

with thrombectomy, autogenous or nonautogenous dialysis graft (separate 36833 5184 J1 $4,377 procedure)

Distal revascularization and interval ligation (DRIL), upper extremity 36838 5184 J1 $4,377hemodialysis access (steal syndrome)

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic 36901 5182 T $1,094angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report;

with transluminal balloon angioplasty, peripheral dialysis segment, 36902 5192 J1 $4,679 including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

with transcatheter placement of intravascular stent(s), peripheral dialysis 36903 5193 J1 $9,669 segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment

Percutaneous transluminal mechanical thrombectomy and/or infusion for 36904 5192 J1 $4,679thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);

with transluminal balloon angioplasty, peripheral dialysis segment, 36905 5193 J1 $9,669 including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

with transcatheter placement of intravascular stent(s), peripheral dialysis 36906 5194 J1 $15,355 segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Status Indicators: J1-Hospital Part B Services Paid Through a Comprehensive APC; N-ltems and Services Packaged into APC Rates; T-Procedure or Service, Multiple Procedure Reduction Applies.C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-F, Centers for Medicare and Medicaid Services.

REIMBURSEMENTB

Procedure

HOSPITAL OUTPATIENT REVIEW

Hospital Outpatient rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA APC SIB RateC

MAINTENANCEA

Transluminal balloon angioplasty, central dialysis segment, performed through +36907 ---- N ----dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)

Transcatheter placement of intravascular stent(s), central dialysis segment, +36908 ---- N ----performed through dialysis circuit, including all imaging and radiologicalsupervision and interpretation required to perform the stenting, and allangioplasty in the central dialysis segment (List separately in addition to codefor primary procedure)

Dialysis circuit permanent vascular embolization or occlusion (including main +36909 ---- N ----circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

Revascularization, endovascular, open or percutaneous, femoral, 37224 5192 J1 $4,679popliteal artery(s), unilateral; with transluminal angioplasty

Hemodialysis access flow study to determine blood flow in grafts and 90940 ---- N ----arteriovenous fistulae by an indicator method

Duplex scan of hemodialysis access (including arterial inflow, body of access 93990 5522 Q1 $113and venous outflow)

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Status Indicators: J1-Hospital Part B Services Paid Through a Comprehensive APC; N-ltems and Services Packaged into APC Rates; Q1-STV-Packaged Codes.C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-CN2, Centers for Medicare and Medicaid Services.

REIMBURSEMENTB

Procedure

Other

HOSPITAL OUTPATIENT REVIEW

ASC rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA Rate

CREATIONA

Insertion of cannula for hemodialysis, other purpose (separate procedure); 36818 $2,249arteriovenous, external revision, or closure

by upper arm cephalic vein transposition 36819 $2,249

by forearm vein transposition 36820 $2,249

direct, any site (eg, Cimino type) (separate procedure) 36821 $1,306

Creation of arteriovenous fistula by other than direct arteriovenous 36825 $2,249anastomosis (separate procedure); autogenous graft

nonautogenous graft (eg, biological collagen, thermoplastic graft) 36830 $2,249ImagingInjection procedure for extremity venography (including introduction of 36005needle or intracatheter)

Venography, extremity, unilateral, radiological supervision and interpretation 75820

Venography, extremity, bilateral, radiological supervision and interpretation 75822

Duplex scan of extremity veins including responses to compression and other 93971 Non-Coveredmaneuvers; unilateral or limited studyMAINTENANCEA

Thrombectomy, open, arteriovenous fistula without revision, autogenous or 36831 $2,249nonautogenous dialysis graft (separate procedure)

Revision, open, arteriovenous fistula; without thrombectomy, autogenous or 36832 $2,249nonautogenous dialysis graft (separate procedure)

with thrombectomy, autogenous or nonautogenous dialysis graft (separate 36833 $2,249 procedure)

Distal revascularization and interval ligation (DRIL), upper extremity 36838 Non-Coveredhemodialysis access (steal syndrome)

Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic 36901 $523angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report;

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-CN2, Centers for Medicare and Medicaid Services.

Procedure

Packaged

Packaged

Packaged

REIMBURSEMENTB

AMBULATORY SURGERY CENTER (ASC)

ASC rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA Rate

MAINTENANCEA

with transluminal balloon angioplasty, peripheral dialysis segment, 36902 $2,003 including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

with transcatheter placement of intravascular stent(s), peripheral dialysis 36903 $6,003 segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment

Percutaneous transluminal mechanical thrombectomy and/or infusion for 36904 $2,003thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);

with transluminal balloon angioplasty, peripheral dialysis segment, 36905 $4,058 including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

with transcatheter placement of intravascular stent(s), peripheral dialysis 36906 $9,726 segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit

Transluminal balloon angioplasty, central dialysis segment, performed through +36907dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)

Transcatheter placement of intravascular stent(s), central dialysis segment, +36908performed through dialysis circuit, including all imaging and radiologicalsupervision and interpretation required to perform the stenting, and allangioplasty in the central dialysis segment (List separately in addition to codefor primary procedure)

Dialysis circuit permanent vascular embolization or occlusion (including main +36909circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

Revascularization, endovascular, open or percutaneous, femoral, 37224 $2,888popliteal artery(s), unilateral; with transluminal angioplasty

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-CN2, Centers for Medicare and Medicaid Services.

Packaged

Packaged

Packaged

REIMBURSEMENTB

Procedure

AMBULATORY SURGERY CENTER (ASC)

ASC rates effective January 1, 2019 through December 31, 2019

PROCEDUREA CODINGHCPCS/CPT®

CodeA Rate

MAINTENANCEA

Hemodialysis access flow study to determine blood flow in grafts and 90940 Non-Coveredarteriovenous fistulae by an indicator method

Duplex scan of hemodialysis access (including arterial inflow, body of access 93990 Non-Coveredand venous outflow)

A. Listed are common procedures. Review CPT® coding guidelines, modifiers, and NCCI edits for these codes. Current Terminology (CPT®) is a registered trademark of the American Medical Association (AMA). Copyright 2019 AMA. All rights reserved.B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-CN2, Centers for Medicare and Medicaid Services.

Other

REIMBURSEMENTB

AMBULATORY SURGERY CENTER (ASC)