Page 1 of 27 CRV-328302-AA JUL2015
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
CY2016 Medicare Proposed Rules Issued for Hospital Outpatient, Ambulatory Surgical Center and Physician Fee Schedule Interventional Cardiology, Peripheral Interventions, Rhythm Management Summary: On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2016 proposed policies and payment rates for Medicare’s Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC). CMS also released the CY 2016 proposed rule and payment rates for the Physician Fee Schedule (PFS) on July 8, 2015. As is customary, CMS provides the public an opportunity to comment on proposed changes prior to finalizing their decisions in the Final Rules. The final policy and payment rate are expected around November 1, 2015, and go into effect January 1, 2016. Hospital Outpatient Prospective Payment System CMS estimates that total OPPS payments would decrease by $43 million (0.1 percent), holding case-mix and volume constant. See Table 1 for interventional cardiology, peripheral interventions, and rhythm management related procedures.
Important OPPS Policy Changes Affect Cardiovascular Procedures Proposed Change to Device Edit Policy (C-Codes) - In CY 2015, CMS finalized a policy whereby any claim assigned to a comprehensive APC required the C-code for the device to be included on the claim for the claim to be processed regardless of whether the comprehensive APC was considered device intensive (i.e. 40% of the cost of the procedure were attributable to the cost of the device). For CY 2016, CMS is proposing to modify this policy so only comprehensive APCs that are found to be device intensive will require the C-code on the claim in order to be processed. Claims submitted with a procedure code requiring a device C-code assigned to an APC would be denied and returned to the provider. Cardiovascular APCs include: pacemakers, ICDs, coronary interventions, and peripheral interventional procedures.
CY 2016 APC
CY 2015 APC
CY 2015 APC Title
5221 0105 Level I Pacemaker
5222
0090 Level II Pacemaker
5223 0089 Level III Pacemaker
5224 0655 Level IV Pacemaker
5231 0107 Level I ICD
5232 0108 Level II ICD
5192 0229 Level II Endovascular
5193 0319 Level III Endovascular
Proposed Adjustment to OPPS Payments for Discontinued Device Intensive Procedures - CMS has long instructed hospitals regarding the use of modifiers (-73 discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia, -74 Discontinued outpatient hospital/ASC procedure after the administration of anesthesia, and -52 Reduced services) for when hospitals have to discontinue a procedure and still need to be paid for the services rendered. In this proposed rule, CMS is clarifying how the device costs for device intensive procedures will be handled for those procedures that are discontinued prior to the administration of anesthesia (i.e. -73, potential for -52). CMS is proposing for CY 2016 to reduce the APC payment by 100% of the device cost offset amount for those device intensive procedures discontinued prior to the induction of anesthesia. However when anesthesia (including local) is used primarily for interventions, CMS will continue to reimburse at 100% (i.e. -74).
Page 2 of 27 CRV-328302-AA JUL2015
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
Multiple Imaging Composite APCs – CMS proposes continuing to provide a single payment for multiple imaging services done within the same imaging family on the same day of service. There are three imaging families, Ultrasound, CT/CTA and MRI/MRA. There are five multiple imaging composite APCs, differentiating when CT/CTA and MRI/MRA are done with and without contrast. CMS defines a single imaging session for the “with contrast” composite APCs as at least one or more imaging procedures from the same imaging family performed with contrast on the same date of service. Hospital Outpatient Quality Reporting (OQR) Program – The Hospital OQR Program is a pay for quality data reporting program implemented for outpatient hospital services. Under the program, hospitals must meet administrative, data collection and submission, valuation, and publication requirements or they receive up to a two percentage point reduction in their annual payment update (APU). CMS previously finalized measure set for Hospital OQR Program impacting CY 2016 and subsequent years which includes: OP-3 Median time to Transfer to Another Facility for Acute Coronary Intervention (NQF #0290), among other measures. CMS proposes two new measures for the Program:
For CY 2018: OP-33 External Beam Radiotherapy (EBRT) for Bone Metastases (NQF #1822) For CY 2019: OP-34 Emergency Department Transfer Communication (EDTC) (NQF #0291)
Short Inpatient Hospital Stay (Two-Midnight Rule) - CMS adopted the Two-Midnight Rule for hospital inpatient admissions beginning on October 1, 2013, with the intent to provide greater clarity to hospital and physician stakeholders for when an inpatient admission is reasonable and eligible for payment. As a result of input, CMS is proposing the following:
Allow inpatient admission less than two-midnights on a case-by case basis based on the judgment of the admitting physician. Documentation must support the medical necessity of the admission and is subject to review.
No change for stays over two-midnight stays. The physician needs to continue to document the medical rationale for the expected length of stay and hospital admission.
CMS also proposes to change the Recovery Audit Contractor (RAC) medical review policy including reducing the look back period from 6 months to 3 months when hospitals rebill an inpatient admission denial as an outpatient claim. Transitional Pass-Through (TPT) Payment - CMS is proposing to modify the process for reviewing applications for transitional pass through payment, allowing for more transparency and public comment. Effective April 1, 2015, CMS established a new device TPT category for drug-coated balloons (DCBs), which applies to LUTONIX DCB. The TPT results in incremental payment to hospitals for outpatient services when a DCB is furnished. In addition to the Drug Coated Balloon category, one other cardiovascular TPT category was approved for wireless pulmonary artery pressure sensors (CardioMEMS). Interventional Cardiology
Complex Percutaneous Coronary Interventions (PCIs) APC 5193 (DES CTO PCI, DES AMI PCI, Stent with Atherectomy; formerly APC 319) payment proposed to decrease 0.52% to $14,768
o 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)
Percutaneous Coronary Interventions (PCIs) APC 5192 (Non-complex stents, BMS CTO, BMS, AMI, atherectomy without stents; formerly APC 229) proposed to increase 0.16% to $9,643
Peripheral Interventions CMS is proposing to assign most PI procedures to newly create APCs. See Table 1 for additional details. Venous and Arterial Mechanical Thrombectomy payments proposed to increase 21.89% to $3,926 AV Fistula Thrombectomy payments proposed to increase 2.10% to $4,634 Iliac PTA, Femoral/Popliteal PTA, and Hemodialysis Access Management (HAM) PTA payments proposed to increase by
2.10% to $4,634 Embolization payments proposed to increase 0.16% to $9,643 Tibial/Peroneal PTA, Iliac Stenting, Femoral/Popliteal Stenting, and Femoral/Popliteal Atherectomy payments proposed to
increase by 0.16%% to $9,643 Tibial/Peroneal Stenting, Tibial/Peroneal Atherectomy, and Combined PTA/Stent/Atherectomy payments proposed to
decrease by 0.52% to $14,768 Rhythm Management
Proposed payment rates for ICD system implants would decrease by 0.15% and ICD replacement procedures would decrease by 3.19%
Single and dual chamber pacemaker system implants would decrease by 1.04% and pacemaker replacements (dual and single chamber) would increase 3.47%
Proposed payment rates for ablation procedures performed in conjunction with a comprehensive EP study, which includes most ablation procedures, would increase by 8.37%
WATCHMAN™ Left Atrial Appendage Closure procedure (0281T) is restricted to the inpatient hospital site of service
Page 3 of 27 CRV-328302-AA JUL2015
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
Ambulatory Surgical Center: Overall ASC payments rates proposed to increase $186 million (1.4%) over CY 2015 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 1.0% of PI procedures are performed within the ASC
Rhythm Management CRT-D/ICD/S-ICD system implants in the ASC are proposed to decrease by 1.02% Dual chamber pacemaker system implant payment rates as well as replacements are proposed to decrease by 1.32%
Physician Fee Schedule Table 3 CY 2015 final rates are calculated using the current conversion factor (CF) of $35.9335 which remains effective until December 31, 2015, moving to $36.1096 beginning January 1, 2016. Overview: Physician Fee Schedule (PFS) - Until this year, annual updates to physician fees followed the Sustainable Growth Rate (SGR) methodology. The SGR methodology threatened annual cuts of 15-30% each year in physician rates since the early 2000s, requiring Congress to pass a “doc fix” each year to avoid politically unsustainable cuts in physician reimbursement. Earlier this year Congress repealed the SGR method and replaced it with a fixed annual update with a transition to a pay for value method. In the proposed rule, CMS continues to implement these changes to the physician payment methodology. Changes include a 0.5% annual raise through 2019 for Medicare participating providers, then moving to an incentive-based payment system designed to encourage participation in alternative payment models (APM). Merit-Based Incentive Payment System (MIPS) will begin impacting physician payments in 2019. Table 3 final rates are calculated with the current conversion factor (CF) of $35.9335 which remains effective until December 31, 2015, moving to $36.1096 beginning January 1, 2016. Other Proposed Policy Changes:
Misvalued Services - CMS and other policy analysts believe that there are a number of services for which reimbursement rates may be incorrect relative to the approximate cost of delivering the services. These are commonly referred to as misvalued services. CMS has proposed 118 services as being potentially misvalued and in need of review. By reducing payments for misvalued services, CMS aims to reduce payments by 1.0% in 2016 and by 0.5% in 2017 and 2018. Cardiovascular procedure codes identified by CMS as being potentially misvalued include: arterial catheter placement, multiple device monitoring codes, and the code for 3-D mapping. CMS now invites comments on the methodology and services identified for inclusion in the calculation. Physician Value-Based Modifier - CMS continues to implement the value-based payment modifier for physicians. The program translates quality and cost performance into payment incentives for those who provide high quality, efficient care, while those who underperform may be subject to a downward adjustment. CMS proposes a +/- 4% adjustment for practices with 10 or more providers and +/- 2% for 9 or less impacting CY 2018 payments, based on CY 2016 reporting. The value-based modified adjustment will end in 2018, to be replaced by the Merit-based Incentive Payment System (MIPS). Physician Quality Reporting System (PQRS) - CMS continues implementing PQRS, proposing new measures that if finalized, would result in 300 measures in the PQRS measure set for 2016. If an individual eligible provider or group practice does not satisfactorily report these quality measures, a 2% negative payment adjustment would apply in 2018, based on 2016 reporting. The PQRS will end in 2018 and starting on January 1, 2019 the Merit-based Incentive Payment System (MIPS) will begin.
Global Surgical Package - In 2015, CMS considered addressing the valuation and coding of global surgical packages, which would have revalued 10 and 90-day global CPT codes to 0-day CPT codes. Congress stepped in and stopped the implementation of this 2015 proposal and instead CMS will now develop a process to gather information needed to potentially send surgical services for review under misvalued services. This data has to begin no later than January 1, 2017 and be from a representative sample of surgeons. The collected information must include the number and level of medical visits furnished during the global period and other items and services related to the surgery, as appropriate.
Page 4 of 27 CRV-328302-AA JUL2015
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
Interventional Cardiology Coronary Stenting
PCIs payment rates are relatively stable o CTO and AMI PCIs proposed to increase by $3 to $710 o Atherectomy with stent payment rate proposed to increase $2 to $709
Stent\PTCA payment rate proposed to increase by $3 to $634 Atherectomy without stent proposed to increase by $3 to $378 Angioplasty payment rate proposed to increase by $2 to $571
Structural Heart-Valves
TAVR range of codes stable, proposed to increase an average of 0.3% with a range of $1,428-$2,024
Peripheral Interventions Physician In-Facility reimbursement is flat overall, while reimbursement to physicians for procedures done in their office is proposed to
increase 0.90% In-Facility and In-office payments for PTA, Stenting, Atherectomy, and thrombectomy remained stable with none of the
payments changing more than 1.50%
Rhythm Management Cardiac Rhythm Management device related procedures remain stable with an average increase of 0.05% Electrophysiology procedures remain stable with an average decrease of 0.48% Several device monitoring codes, including the codes for remote monitoring have been identified as potentially
misvalued. Also identified as potentially misvalued is the code for 3-D mapping
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 CY2016 Proposed Payment Rates Table 2: ASC CY2016 Proposed Payment Rates Table 3: Physician CY2016 Proposed Fee Schedule
Comments or Questions If you have questions or would like additional information please contact:
Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM)
Deb Lorenz Brent Hale Reimbursement Support Line
763-494-2112 763-494-1448 1-800-CARDIAC
[email protected] [email protected] [email protected]
Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes on and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.
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.
APC Descriptor
CY2016
Proposed
Rate
CY2015 Final
Rate
Variance
2016 Proposed vs.
2015 Final
% YoY
Change
Interventional Cardiology
5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02%
Level I Endovascular Procedures (previously APC 83)
PTCA (92920)
Level II Endovascular Procedures (previously APC 229)
DES w/ PTCA (C9600), DES Bypass Graft (C9604), BMS w/ PTCA
(92928), BMS Bypass Graft (92937), BMS AMI PCI (92941), BMS
CTO PCI (92943), PTCA/Atherectomy (92924)
Complexity Adjustments:
PTCA + PTCA (92920 + 92920), PTCA + PTCA add branch (92920 +
92921)
Level III Endovascular Procedures (previously APC 319)
DES CTO PCI (C9607), DES AMI PCI (C9606), DES w/Atherectomy
(C9602), BMS w/Atherectomy (92933)
Complexity Adjustments:
DES + DES (C9600 + C9600), DES + DES add branch (C9600 +
C9601), DES + Coronary Angio / Atherectomy (C9600 + 92924),
DES Bypass Graft + DES (C9604 + C9600), DES Bypass Graft + DES
add branch (C9604 + C9601), DES + DES Bypass Graft add branch
(C9600 + C9605), DES Bypass Graft + DES Bypass Graft (C9604 +
C9604), DES Bypass Graft + DES Bypass Graft add branch (C9604 +
C9605), BMS Stent + DES Stent add branch (92928 + C9601), DES
+ Vasc Stent (C9600 + 37236), DES + Iliac Stent (C9600 + 37221),
DES + Insert Pacemaker (C9600 + 33208), DES + Insert Electrode
(C9600 + 33210)
Peripheral Interventions
5183
Level 3 Vascular Procedures (previously APC 88)
Arterial Mechanical Thrombectomy (37184), Venous Mechanical
Thrombectomy (37187)
$3,926 $3,221 $705 21.89%
Level I Endovascular Procedures (previously APC 83)
Iliac PTA (37220), FemPop PTA (37224), AV Fistula Thrombectomy
(36870)
Level II Endovascular Procedures (previously APC 229)
TibPer PTA (37228), Iliac Stent (37221), FemPop Atherectomy
(37225), FemPop Stent (37226), Vasc Embolization (37241‐37244)
Complexity Adjustment:
AV Fistula Thrombectomy + AV Fistula Thrombectomy (36870 +
36870)
Table 1: CY2016 Hospital Outpatient Proposed Payment Rates for Select Procedures
5191* $4,634 $4,539 $95 2.10%
0.16%5192
‐0.52%
5191
0.16%
2.10%
5192
BSC currently has no stents FDA‐approved for CTOs
*
$14,768 $14,846 ‐$785193*
$9,643 $9,628 $15
* $4,634 $4,539 $95
* $9,643 $9,628 $15
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
Page 5 of 27 CRV-328302-AA JUL2015
APC Descriptor
CY2016
Proposed
Rate
CY2015 Final
Rate
Variance
2016 Proposed vs.
2015 Final
% YoY
Change
Table 1: CY2016 Hospital Outpatient Proposed Payment Rates for Select Procedures
Level III Endovascular Procedures (previously APC 319)
FemPop Stent & Atherectomy (37227), TibPer Atherectomy
(37229), TibPer Stent (37230), TibPer Stent & Atherectomy
(37231)
Complexity Adjustments:
Iliac Stent + Vasc Stent (37221 + 37236), FemPop Atherectomy +
Iliac Stent (37225 + 37221), FemPop Atherectomy + Vasc Stent
(37225 + 37236), FemPop Stent + Iliac Stent (37226 + 37221),
FemPop Stent + FemPop Atherectomy (37226 + 37225), FemPop
Stent + FemPop Stent (37226 + 37226), FemPop Stent + Vasc
Stent (37226 + 37236), FemPop Stent + DES (37226 + C9600),
Vasc embo venous + Vasc stent (37241 + 37238), Vasc embo
artery + Iliac stent (37242 + 37221), Vasc Stent + Vasc Stent
(37236 + 37238), Vasc Stent + Vasc Stent (37238 + 37238)
5352
Level 2 Percutaneous Abdominal/Biliary Procedures and Related
Procedures (previously APC 423)
Biliary Stent (47556)
$4,152 $4,096 $56 1.37%
2616 Brachytx, non‐str,Yttrium‐90 $15,853 $15,583 $271 1.74%
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
Rhythm Management
5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02%
Level 1 EP Procedures (previously APC 84)
Right ventricular recording (93603)
Induction of arrthymia (93618)
DFT testing not at implant (93642)
Level 2 EP Procedures (previously APC 85)
Bundle of HIS recording (93600)
Intra‐atrial recording (93602)
Intra‐atrial pacing (93610)
Intraventricular pacing (93612)
Comprehensive EP study without induction (93619)
Comprehensive EP study with induction (93620)
EP follow up study (93624)
AV Node Ablation (93650)
Level 3 EP Procedures (previously APC 86)
SVT ablation with EP study (93653)
VT ablation with EP study (93654)
A Fib ablation with EP study (93656)
*
*
*
‐4.04%‐$35$873$8385211
$14,362$15,564
2.49%$115$4,635$4,7505212
5213 8.37%$1,202
‐0.52%* 5193 $14,768 $14,846 ‐$78
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
Page 6 of 27 CRV-328302-AA JUL2015
APC Descriptor
CY2016
Proposed
Rate
CY2015 Final
Rate
Variance
2016 Proposed vs.
2015 Final
% YoY
Change
Table 1: CY2016 Hospital Outpatient Proposed Payment Rates for Select Procedures
Level 1 Pacemaker and Similar Procedures (previously APC 0105)
Repair single transvenous electrode (33218)
Repair 2 transvenous electrodes (33220)
Removal of pacemaker generator only (33233)
Removal of transvenous pacemaker electrode ‐ single (33234)
Removal of transvenous pacemaker electrode ‐ dual (33235)
Removal of ICD pulse generator only (33241)
Removal of ICD electrode(s) (33244)
Removal of S‐ICD electrode (33272)
Repositioning of S‐ICD electrode (33273)
Level 2 Pacemaker and Similar Procedures (previously APC 90)
Insertion of single chamber pacemaker generator only (33212)
Insertion of single transvenous electrode, pacemaker or ICD
(33216)
Insertion of 2 transvenous electrodes, pacemaker or ICD (33217)
Single chamber pacemaker change out (33227)
Insertion of S‐ICD electrode (33271)
Level 3 Pacemaker and Similar Procedures (Previously APC 89)
Insertion of single and dual chamber pacemaker (33206,33207,
33208)
Insertion of dual chamber pacemaker generator only (33213)
Upgrade of single to dual chamber pacemaker (33214)
LV lead insertion with attachment to previously placed device
(33224)
Dual chamber pacemaker change out (33228)
Removal of PM generator + LV pacing lead add‐on (33233 +
33225)
Implant pat‐active ht record + EP Eval (33282 + 93619)
Level 4 Pacemaker and Similar Procedures (previously APC 655)
Insertion of multiple lead pacemaker generator only (33221)
Multiple lead pacemaker change out (33229)
Insert PM ventricular + LV lead add‐on (33207 + 33225), Insert
PM atrial & Vent + LV 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 + LV pacing lead add‐on
(33228 + 33225)
*
*
$16,985 $16,407 $578 3.52%*
3.47%$227$6,545$6,7725222
‐39.03%‐$2,554
‐1.05%‐$99$9,493$9,3945223
5221 $3,991 $6,545
5224
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
Page 7 of 27 CRV-328302-AA JUL2015
APC Descriptor
CY2016
Proposed
Rate
CY2015 Final
Rate
Variance
2016 Proposed vs.
2015 Final
% YoY
Change
Table 1: CY2016 Hospital Outpatient Proposed Payment Rates for Select Procedures
Level 1 ICD and Similar Procedures (ICD/S‐ICD PG only)
(previously APC 107)
Insertion of single and dual lead defibrillator pulse generator only
(33240,33230)
Single or dual lead ICD change out (33262, 33263)
Insert PM ventricular + LV lead add‐on (33207 + 33225)
Insert PM atrial & Vent + LV 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 + LV pacing lead add‐on (33228 +
33225)
Level 2 ICD and Similar Procedures (previously APC 108)
Insertion of mulitiple lead defibrillator pulse generator only
(33231)
Insertion of single or dual chamber transvenous ICD system
(33249)Multiple lead ICD change out (33264)
Insertion of subcutaneous ICD system (33270)
CRT‐D system implant (33249 + 33225)
*
5232* $30,771 $30,818
$22,186 $22,917
Symbol notes comprehensive APC
Common Procedural Terminology (CPT) copyright 2014 American Medical Association. All rights reserved.
* ‐$731 ‐3.19%
‐$47 ‐0.15%
5231
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
Page 8 of 27 CRV-328302-AA JUL2015
CY2016
Proposed
Payment
CY2015 Final
Payment
$ $ $ %
Peripheral Interventions
Hemodialysis PTA
35476Transluminal balloon angioplasty, percutaneous; venous
$1,256 $1,242 $15 1.18%
35475Transluminal balloon angioplasty, percutaneous; brachiocephalic
trunk or branches, each vessel$1,328 $1,317 $11 0.84%
Thrombectomy
36870Thrombectomy, percutaneous, arteriovenous fistula, autogenous or
nonautogenous graft (includes mechanical thrombus extraction and
intra‐graft thrombolysis)
$2,289 $2,220 $69 3.12%
37184
Primary percutaneous transluminal mechanical thrombectomy,
noncoronary, arterial or arterial bypass graft, including fluoroscopic
guidance and intraprocedural pharmacological thrombolytic
injection(s); initial vessel
$2,175 $1,765 $410 23.21%
37187
Percutaneous transluminal mechanical thrombectomy, vein(s),
including intraprocedural pharmacological thrombolytic injections
and fluoroscopic guidance
$2,175 $1,765 $410 23.21%
Trach Bronch Stent
31631Bronchosopy (rigid or flexible); with tracheal dilation and placement
of tracheal stent$1,979 $1,236 $742 60.05%
Biliary Stenting
47556Biliary endoscopy, percutaneous via T‐tube or other tract; with
dilation of biliary duct stricture(s) with stent$2,300 $2,244 $55 2.47%
49421 Insert abdom drain, perm $1,465 $1,254 $211 16.84%
49423 Exchange drainage catheter $669 $706 ($37) ‐5.28%
Table 2: Ambulatory Surgical Center (ASC)
ASC CY2016 Proposed Payment Rates for Select Procedures
Variance 2016 Proposed
vs. 2015 FinalAbbreviated (Partial) DescriptionCPT®
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
Page 9 of 27 CRV-328302-AA JUL2015
CY2016
Proposed
Payment
CY2015 Final
Payment
$ $ $ %
Table 2: Ambulatory Surgical Center (ASC)
ASC CY2016 Proposed Payment Rates for Select Procedures
Variance 2016 Proposed
vs. 2015 FinalAbbreviated (Partial) DescriptionCPT®
Rhythm Management
33208 Pacemaker ‐ dual chamber system implant $7,749 $7,853 ($104) ‐1.32%
33213 Pacemaker ‐ dual chamber pulse generator only $7,749 $7,853 ($104) ‐1.32%
33240Insertion of ICD / S‐ICD pulse generator only with existing lead
$19,763 $20,292 ($530) ‐2.61%
33249 ICD system implant $26,935 $27,212 ($277) ‐1.02%
33262Removal with replacement of ICD / S‐ICD pulse generator only with
existing electrode $19,763 $20,292 ($530) ‐2.61%
33270 S-ICD system implant $26,935 $27,212 ($277) ‐1.02%
33249 +
33225
CRT‐D System implant (33249 & 33225 when performed on the
same day)$27,204 $27,212 ($8) ‐0.03%
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 10 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Interventional Cardiology
Diagnostic Catheterization
93451 26 $151 $0 0.25% $151 $0 0.25%
93451 NA NA NA $805 $7 0.85%
93452 26 $263 ($1) ‐0.33% $263 ($1) ‐0.33%
93452 NA NA NA $907 $5 0.57%
93453 26 $346 ($1) ‐0.34% $346 ($1) ‐0.34%
93453 NA NA NA $1,167 $6 0.49%
93454 26 $266 ($0) ‐0.05% $266 ($0) ‐0.05%
93454 NA NA NA $919 $6 0.65%
93455 26 $307 ($1) ‐0.21% $307 ($1) ‐0.21%
93455 NA NA NA $1,070 $7 0.63%
93456 26 $341 ($2) ‐0.46% $341 ($2) ‐0.46%
93456 NA NA NA $1,151 $8 0.71%
93457 26 $382 ($0) ‐0.08% $382 ($0) ‐0.08%
93457 NA NA NA $1,302 $11 0.88%
93458 26 $325 $1 0.27% $325 $1 0.27%
93458 NA NA NA $1,103 $9 0.79%
93459 26 $366 $1 0.29% $366 $1 0.29%
93459 NA NA NA $1,219 $10 0.82%
93460 26 $408 $0 0.05% $408 $0 0.05%
93460 NA NA NA $1,307 $9 0.68%
93461 26 $450 ($0) ‐0.07% $450 ($0) ‐0.07%
93461 NA NA NA $1,495 $11 0.73%
93462
Left heart catheterization by transseptal puncture through
intact septum or by transapical puncture (List separately in
addition to code for primary procedure)
$218 $2 0.82% $218 $2 0.82%
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 $0 0.13% $101 $0 0.13%
93464 26 $90 $0 0.49% $90 $0 0.49%
93464 NA NA NA $281 $2 0.75%
93531 26Combined right heart catheterization and retrograde left heart
cath, for congenital cardiac anomalies$447 ($9) ‐1.89% $447 ($9) ‐1.89%
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
$556 ($8) ‐1.49% $556 ($9) ‐1.56%
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
$370 ($8) ‐2.09% $370 ($8) ‐2.09%
Table 3: Physician Fee Schedule CY2016 Proposed Rule Payment Rates
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary
Right heart catheterization including measurement(s) of oxygen
saturation and cardiac output, when performedLeft heart catheterization including intraprocedural injection(s)
for left ventriculography; imaging supervision and Combined right heart cath and left heart catheterization
including intraprocedural injection(s) for left ventriculography, Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary Catheter placement in coronary artery(s) for coronary
angiography, including intraprocedural injection(s) for coronary
Physiologic exercise study (eg, bicycle or arm ergometry)
including assessing hemodynamic measurements before and
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
Page 11 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Diagnostic Cath Injection
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 ($0) ‐1.01% $48 ($0) ‐1.01%
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)
$49 $1 1.24% $176 $2 1.11%
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)
$55 $1 1.15% $146 $1 0.74%
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)
$50 $1 1.22% $158 $1 0.95%
Angioplasty without Stent
92920Percutaneous transluminal coronary angioplasty; single major
coronary artery or branch$571 $2 0.36% NA NA NA
92921
Percutaneous transluminal coronary angioplasty; each
additional branch of a major coronary artery (list separately in
addition to code for primary procedure)
$0 $0 NA $0 $0 NA
Atherectomy without Stent
92924
Percutaneous transluminal coronary atherectomy, with
coronary angioplasty when performed; single major coronary
artery or branch
$678 $3 0.38% NA NA NA
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)
$0 $0 NA $0 $0 NA
Stent with Angioplasty
92928
Percutaneous transcatheter placement of intracoronary
stent(s), with coronary angioplasty when performed; single
major coronary artery or branch
$634 $3 0.43% NA NA NA
92929
Percutaneous transcatheter placement of intracoronary
stent(s), with coronary angioplasty when performed; each
additional branch of a major coronary artery (list separately in
addition to code for primary procedure)
$0 $0 NA $0 $0 NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 12 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Stent with Atherectomy
92933
Percutaneous transluminal coronary atherectomy, with
intracoronary stent, with coronary angioplasty when
performed; single major coronary artery or branch
$709 $2 0.34% NA NA NA
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
Bypass Graft
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
$634 $3 0.43% 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
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
$710 $3 0.39% NA NA NA
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
$710 $3 0.49% NA NA NA
92944
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)
$0 $0 NA $0 $0 NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 13 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Thrombectomy
92973 Percutaneous transluminal coronary thrombectomy mechanical $186 $1 0.49% NA NA NA
IVUS
92978 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 ($2) ‐1.64% $100 ($2) ‐1.64%
92979 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 ($1) ‐1.29% $80 ($1) ‐1.29%
FFR
93571 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 ($2) ‐1.64% $100 ($2) ‐1.64%
93572 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 ($1) ‐1.29% $80 ($1) ‐1.29%
Valvuloplasty
92986 Percutaneous balloon valvuloplasty; aortic valve $1,394 $6 0.41% NA NA NA
92987 Percutaneous balloon valvuloplasty; mitral valve $1,437 $6 0.41% NA NA NA
92990 Percutaneous balloon valvuloplasty; pulmonary valve $1,135 $2 0.17% NA NA NA
Transcatheter Aortic Valve Replacement
33361Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; percutaneous femoral artery approach$1,428 $7 0.49% NA NA NA
33362Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; open femoral artery approach$1,560 $7 0.44% NA NA NA
33363Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; open axillary artery approach$1,621 ($11) ‐0.66% NA NA NA
33364Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; open iliac artery approach$1,699 $8 0.49% NA NA NA
33365
Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; transaortic approach (e.g., median
sternotomy, mediastinotomy)
$1,871 $9 0.49% NA NA NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 14 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
33366Transcatheter aortic valve replacement (TAVR/TAVI) with
prosthetic valve; transapical exposure (eg, left thoracotomy)$2,024 $9 0.44% NA NA NA
33367
Transcatheter aortic valve replacement (tavr/tavi) with
prosthetic valve; cardiopulmonary bypass support with
percutaneous peripheral arterial and venous cannulation (e.g.,
femoral vessels) (list separately in addition to code for primary
procedure)
$658 $5 0.77% 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)
$788 $3 0.44% 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)
$1,042 $7 0.70% NA NA NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 15 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Peripheral Interventions
Non‐Coronary Angioplasty
35475Transluminal balloon angioplasty, percutaneous;
brachiocephalic trunk or branches, each vessel$351 ($0) ‐0.13% $1,606 $10 0.63%
35476 Transluminal balloon angioplasty, percutaneous; venous $284 ($0) ‐0.15% $1,473 $14 0.94%
Radiological S&I (Non‐Cor Angioplasty)
75962 26 $27 $1 4.62% $27 $1 4.62%
75962 NA NA NA $144 $4 2.82%
75964 26 $18 $0 2.54% $18 $0 2.54%
75964 NA NA NA $90 $3 3.40%
75966 26 $66 $0 0.49% $66 $0 0.49%
75966 NA NA NA $175 $2 0.91%
75968 26 $18 $0 2.50% $18 $0 2.50%
75968 NA NA NA $89 ($0) ‐0.32%
75978 26 $27 $1 4.62% $27 $1 4.62%
75978 NA NA NA $142 $3 2.32%
Iliac Artery Revascularization
37220Revascularization, endovascular, open or percutaneous, iliac
artery, unilateral, initial vessel; with transluminal angioplasty$439 ($0) 0.00% $3,262 $31 0.95%
37221
Revascularization, endovascular, open or percutaneous, iliac
artery, unilateral, initial vessel; with transluminal stent
placement(s), includes angioplasty within same vessel, when
performed
$541 $1 0.16% $4,808 $43 0.91%
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)
$199 $1 0.31% $916 $9 1.05%
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)
$227 $0 0.01% $2,674 $20 0.73%
Femoral/Popliteal Artery Revascularization
37224
Revascularization, endovascular, open or percutaneous,
femoral/popliteal artery(s), unilateral; with transluminal
angioplasty
$484 ($0) ‐0.03% $3,957 $37 0.94%
37225
Revascularization, endovascular, open or percutaneous,
femoral/popliteal artery(s), unilateral; with atherectomy,
includes angioplasty within same vessel, when performed
$657 $2 0.38% $11,377 $101 0.90%
Transluminal balloon angioplasty, peripheral artery other than
cervical carotid, renal or other visceral artery, iliac or lower Transluminal balloon angioplasty, each additional peripheral
artery other than cervical carotid, renal or other visceral artery, Transluminal balloon angioplasty, renal/visceral artery,
radiological S&ITransluminal balloon angioplasty, renal/visceral, each additional
artery, S&I (List separately in addition to code for primary Transluminal balloon angioplasty, venous (eg, subclavian
stenosis), radiological S&I
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 16 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
37226
Revascularization, endovascular, open or percutaneous,
femoral/popliteal artery(s),unilateral;with transluminal stent
placement(s), includes angioplasty within the same vessel,
when performed
$569 $0 0.05% $9,352 $79 0.86%
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
$789 $2 0.26% $15,365 $138 0.91%
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
Tibeal / Peroneal Artery Revascularization
37228
Revascularization, endovascular, open or percutaneous,
tibeal\peroneal artery, unilateral, initial vessel; with
transluminal angioplasty
$591 $0 0.06% $5,623 $48 0.86%
37229
Revascularization, endovascular, open or percutaneous,
tibeal\peroneal artery, unilateral, initial vessel; with
atherectomy, includes angioplasty within the same vessel, when
performed
$765 $1 0.16% $11,208 $84 0.75%
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
$754 $0 0.06% $8,572 $66 0.78%
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
$819 $0 0.05% $13,793 $127 0.93%
37232
Revascularization, endovascular, open or percutaneous,
tibeal\peroneal artery, unilateral, each additional vessel; with
transluminal angioplasty (List separately in addition to code fore
primary procedure)
$215 $1 0.32% $1,253 $9 0.69%
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)
$350 $1 0.28% $1,512 $7 0.44%
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)
$301 ($1) ‐0.23% $4,006 $39 0.97%
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 17 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
37235
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)
$428 $14 3.28% $4,216 ($45) ‐1.05%
37236
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
$478 ($1) ‐0.26% $4,246 $4 0.10%
37237
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)
$226 ($2) ‐0.94% $2,539 ($4) ‐0.16%
37238
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
$331 ($5) ‐1.44% $4,328 $123 2.93%
37239
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)
$158 ($1) ‐0.64% $2,096 $21 0.99%
Catheter Access
36140 Introduction of needle or intracatheter; extremity artery $109 $1 0.83% $448 $1 0.17%
36147 Access av dial grft for eval $195 ($0) ‐0.06% $863 $9 1.08%
36148 Access av dial grft for proc $52 ($0) ‐0.21% $270 $2 0.76%
36160 Introduction of needle or intracatheter, aortic, translumbar $130 ($0) ‐0.34% $509 $2 0.42%
36200 Introduction of catheter, aorta $161 ($0) ‐0.18% $643 $4 0.60%
Catheter Placement
36215Selective catheter placement, arterial system; each first order
thoracic or brachiocephalic branch, within a vascular family$247 ($1) ‐0.24% $1,160 $9 0.74%
36216
Selective catheter placement, arterial system; initial second
order thoracic or brachiocephalic branch, within a vascular
family
$291 $4 1.24% $1,240 $42 3.50%
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 18 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
36217
Selective catheter placement, arterial system; initial third order
or more selective thoracic or brachiocephalic branch, within a
vascular family
$347 $6 1.65% $2,073 $136 7.02%
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)
$56 $1 1.80% $199 $10 5.47%
36245
Selective catheter placement, arterial system; each first order
abdominal, pelvic, or lower extremity artery branch, within a
vascular family
$265 $0 0.08% $1,415 $15 1.08%
36246
Selective catheter placement, arterial system; initial second
order abdominal, pelvic, or lower extremity artery branch,
within a vascular family
$282 ($1) ‐0.28% $918 $5 0.53%
36247
Selective catheter placement, arterial system; initial third order
or more selective abdominal, pelvic, or lower extremity artery
branch, within a vascular family
$334 ($1) ‐0.16% $1,626 $13 0.80%
36248
Selective catheter placement, arterial system; additional second
order, third order, and beyond, abdominal, pelvic, or lower
extremity artery branch, within a vascular family (List in
addition to code for initial second or third order vessel as
appropriate
$52 $0 0.49% $158 $1 0.95%
Carotid Artery Stenting
37215Transcatheter placement of intravascular stent(s), cervical
carotid artery, percutaneous; with distal embolic protection$1,059 ($88) ‐7.64% NA NA NA
37216Transcatheter placement of intravascular stent(s), cervical
carotid artery, percutaneous; without distal embolic protection$0 $0 NA $0 $0 NA
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.
$251 ($0) ‐0.08% $2,718 $24 0.89%
37192
Repositioning of inferior vena cava filter, endovascular
approach including vascular access, vessel selection and
radiological supervision and interpretation (including
ultrasound) when performed.
$386 ($7) ‐1.81% $1,598 ($121) ‐7.03%
37193
Retrieval (removal) of inferior vena cava filter, endovascular
approach including vascular access, vessel selection and
radiological supervision and interpretation (including
ultrasound) when performed.
$385 ($1) ‐0.26% $1,651 $10 0.62%
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 19 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Thrombectomy
36870
Thrombectomy, percutaneous, arteriovenous fistula,
autogenous or nonautogenous graft (includes mechanical
thrombus extraction and intra‐graft thrombolysis)
$315 ($0) ‐0.08% $1,892 $17 0.93%
37184
Primary percutaneous transluminal mechanical thrombectomy,
noncoronary, arterial or arterial bypass graft, including
fluoroscopic guidance and intraprocedural pharmacological
thrombolytic injection(s); initial vessel
$485 ($2) ‐0.33% $2,344 $16 0.68%
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
$178 $1 0.49% $746 $10 1.32%
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)
$263 $0 0.08% $1,423 $12 0.82%
37187
Percutaneous transluminal mechanical thrombectomy, vein(s),
including intraprocedural pharmacological thrombolytic
injections and fluoroscopic guidance
$429 ($0) ‐0.10% $2,124 $10 0.49%
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
$309 $0 0.02% $1,835 $31 1.73%
34101Thrombectomy, with or without catheter; axillary, brachial,
innominate, subclavian artery, by arm incision$641 $2 0.26% NA NA NA
34111Thrombectomy, with or without catheter; radial or ulnar artery,
by arm incision$640 $4 0.60% NA NA NA
34201Thrombectomy, with or without catheter; femoral\popliteal,
aortoiliac artery, by leg incision$1,097 $0 0.03% NA NA NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 20 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
34490Thrombectomy, with or without catheter; axillary and
subclavian vein, by arm incision$654 $6 0.99% NA NA NA
Thrombolysis
37211
Transcatheter therapy, arterial infusion for thrombolysis other
than coronary, any method, including radiological supervision
and interpretation, initial treatment day
$420 ($2) ‐0.37% NA NA NA
37212
Transcatheter therapy, venous infusion for thrombolysis, any
method, including radiological supervision and interpretation,
initial treatment day
$370 $0 0.10% 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
$260 ($1) ‐0.20% 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
$143 ($0) ‐0.27% NA NA NA
Non‐Coronary IVUS
3725A
Intravascular ultrasound (non‐coronary vessel) during diagnostic
evaluation and/or therapeutic intervention; initial vessel (List
separately in addition to code for primary procedure)
$94 ($19) ‐16.81% $1,440 NA NA
3725B
Intravascular ultrasound (non‐coronary vessel) during diagnostic
evaluation and/or therapeutic intervention; each additional
vessel (List separately in addition to code for primary
procedure)
$75 ($10) ‐11.77% $221 NA NA
Radiological S&I (Non‐Cor IVUS)
75945 26Intravascular ultrasound (peripheral vessel) radiological
supervision and interpretation; initial vessel$21 $0 0.49% $21 $0 0.49%
75946 26each additional non‐coronary vessel (List separately in addition
to code for primary procedure)$20 ($0) ‐1.27% $20 ($0) ‐1.27%
Angiograms
75710 26 $58 $2 4.41% $58 $2 4.41%
75710 NA NA NA $167 $4 2.71%
Angiography, extremity, unilateral, radiological supervision and
interpretation
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 21 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
75716 26 $66 ($0) ‐0.06% $66 ($0) ‐0.06%
75716 NA NA NA $192 $3 1.64%
75726 26 $57 ($1) ‐1.38% $57 ($1) ‐1.38%
75726 NA NA NA $153 $1 0.49%
BSC currently has no stents FDA‐approved for use in the infrainguinal regions of the lower extremities
75731 26 $59 $1 2.36% $59 $1 2.36%
75731 NA NA NA $177 $4 2.37%
75733 26 $65 ($0) ‐0.07% $65 ($0) ‐0.07%
75733 NA NA NA $188 $3 1.66%
75736 26 $57 ($3) ‐4.96% $57 ($3) ‐4.96%
75736 NA NA NA $164 ($1) ‐0.82%
Bronchoscopy
31631Bronchosopy; with placement of tracheal stent(s) (inludes
tracheal/bronchial dilation as required)$240 ($0) ‐0.11% NA NA NA
Biliary Stenting
47556Biliary endoscopy, percutaneous via T‐Tube or other tract; with
dilation of biliary duct stricture(s) with stent$437 ($2) ‐0.41% NA NA NA
Radiological S&I (Biliary stenting)
74363 26
Percutaneous transhepatic dilation of biliary duct stricture with
or without placement of stent, radiological supervision and
interpretation
$44 ($1) ‐2.70% $44 ($1) ‐2.70%
Transhepatic Shunts (TIPS)
37182
Insertion of transvenous intrahepatic portosystemic shunt(s)
(TIPS) (includes venous access, hepatic and portal vein cath,
portography with hemodynamic evaluation, intrahepatic tract
formation/dilation, stent placement and all associated imaging
and guidance and documentation)
$873 ($5) ‐0.54% 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)
$413 ($1) ‐0.30% $6,103 $62 1.03%
Embolization
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
$475 $9 1.88% $4,934 $238 5.06%
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
$519 ($1) ‐0.13% $7,914 ($2) ‐0.03%
Angiography, pelvic, selective or supraselective, radiological
supervision and interpretation
Angiography, extremity, bilateral, radiological supervision and
interpretationAngiography, visceral, selective or supraselective (with or
without flush aortogram), radiological supervision and
Angiography, adrenal, unilateral, selective, radiological
supervision and interpretationAngiography, adrenal, bilateral, selective, radiological
supervision and interpretation
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 22 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
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
$612 ($7) ‐1.14% $10,049 $55 0.56%
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
$717 ($5) ‐0.76% $7,000 $6 0.09%
Drainage
47510Introduction of percutaneous transhepatic catheter for biliary
drainage $489 ($1) ‐0.25% NA NA NA
47511Introduction of percutaneous transhepatic stent for internal and
external biliary drainage $598 ($2) ‐0.29% NA NA NA
47525 Change of percutaneous biliary drainage catheter $88 $0 0.08% $537 $5 0.90%
47530 Revision and/or reinsertion of transhepatic tube $364 ($3) ‐0.79% $1,414 $5 0.34%
49421Insertion of intraperitoneal cannula or catheter for drainage or
dialysis; permanent $241 $1 0.34% NA NA NA
50392Introduction of intracatheter or catheter into renal pelvis for
drainage and/or injection, percutaneous NA NA NA NA NA NA
49423Exchange of previously placed abscess or cyst drainage catheter
under radiological guidance (separate procedure)$75 ($1) ‐0.94% $566 $5 0.81%
75980 26Percutaneous transhepatic biliary drainage with contrast
monitoring, radiological supervision and interpretation$72 ($2) ‐2.91% $72 ($2) ‐2.91%
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
$72 ($2) ‐2.45% $72 ($2) ‐2.45%
75984 26
Change of percutaneous tube or drainage catheter with
contrast monitoring (eg, genitourinary system, abscess),
radiological supervision and interpretation
$36 ($0) ‐0.51% $36 ($0) ‐0.51%
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 23 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
Rhythm Management
Device Implant Procedures
33206 Insertion of heart pacemaker and atrial electrode $482 $1 0.26% NA NA NA
33207 Insertion of heart pacemaker and ventricular electrode $514 $2 0.42% NA NA NA
33208 Insertion of heart pacemaker with transvenous electrode $557 $3 0.49% NA NA NA
33212 Insertion of pulse generator only with existing single lead $348 $2 0.49% NA NA NA
33213 Insertion of pulse generator only with existing dual lead $363 $1 0.29% NA NA NA
33221 Insertion of pulse generator only with existing mulitple leads $389 $2 0.58% NA NA NA
33214 Upgrade of pacemaker system $512 $4 0.77% NA NA NA
33215 Reposition pacing‐defib lead $324 $1 0.38% NA NA NA
33216 Insert lead pace‐defib, one $399 $2 0.40% NA NA NA
33217 Insert lead pace‐defib, dual $392 $2 0.49% NA NA NA
33218 Repair of single lead, pacer or ICD $418 $1 0.32% NA NA NA
33220 Repair of 2 leads, pacer or ICD $419 $2 0.40% NA NA NA
33222 Revise/relocate pocket, pacemaker $364 $2 0.69% NA NA NA
33223 Revise pocket, defib $438 $2 0.41% NA NA NA
33225 L ventric pacing lead (add‐on) $489 $2 0.42% NA NA NA
33227 Removal and replacement of pacemaker gen, single lead $366 $1 0.29% NA NA NA
33228 Removal and replacement of pacemaker gen, dual lead $382 $2 0.49% NA NA NA
33229 Removal and replacement of pacemaker gen, multiple lead $402 $4 0.94% NA NA NA
33230 Insert ICD pulse generator with exisitng dual leads $414 $4 1.02% NA NA NA
33231 Insert ICD pulse generator with exisitng multiple leads $431 ($1) ‐0.26% NA NA NA
33233 Removal of pacemaker system gen only $253 $1 0.49% NA NA NA
33234 Removal of pacemaker system lead, single $519 $1 0.28% NA NA NA
33235 Removal pacemaker electrode, dual lead $677 $4 0.60% NA NA NA
33240Insertion of implantable defibrillator pulse generator only; with
existing single lead $394 $2 0.49% NA NA NA
33241 Remove pulse generator only $238 $1 0.34% NA NA NA
33262 Removal and replacement of defib gen, single lead $354 ($45) ‐11.35% NA NA NA
33263 Removal and replacement of defib gen, dual lead $418 $2 0.49% NA NA NA
33264 Removal and replacement of defib gen, multiple lead $435 $2 0.49% NA NA NA
33244 Remove eltrd, transven $909 $4 0.41% NA NA NA
33249 Eltrd/insert pace‐defib $968 $4 0.42% NA NA NA
33270Insertion or replacement of permanent S‐ICD system, with
subcutaneous electrode, including DFT, when performed $618 $5 0.78% NA NA NA
33271 Insertion of S‐ICD electrode $520 $4 0.84% NA NA NA
33272 Removal of S‐ICD electrode $369 ($10) ‐2.75% NA NA NA
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 24 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
33273 Repositioning of previously implanted S‐ICD electrode $421 $3 0.75% NA NA NA
Device Evaluation
93641 26 Electrophysiology evaluation ‐ICD system $339 ($6) ‐1.81% $339 ($6) ‐1.81%
93260 NA NA NA $69 $1 1.02%
93260 TC NA NA NA $23 $0 0.49%
93260 26 $46 $1 1.29% $46 $1 1.29%
93261 NA NA NA $62 ($0) ‐0.67%
93261 TC NA NA NA $22 ($0) ‐1.11%
93261 26 $39 ($0) ‐0.42% $39 ($0) ‐0.42%
93288 NA NA NA $38 ($1) ‐1.41%
93288 TC NA NA NA $16 ($0) ‐1.74%
93288 26 $22 ($0) ‐1.16% $22 ($0) ‐1.16%
93279 NA NA NA $51 $0 0.49%
93279 TC NA NA NA $18 $0 0.49%
93279 26 $33 $0 0.49% $33 $0 0.49%
93280 NA NA NA $59 ($0) ‐0.12%
93280 TC NA NA NA $20 $0 0.49%
93280 26 $39 ($0) ‐0.43% $39 ($0) ‐0.43%
93281 NA NA NA $69 $0 0.49%
93281 TC NA NA NA $23 $0 0.49%
93281 26 $46 $0 0.49% $46 $0 0.49%
93289 NA NA NA $66 $0 0.49%
93289 TC NA NA NA $20 $0 0.49%
93289 26 $47 $0 0.49% $47 $0 0.49%
93282 NA NA NA $64 ($0) ‐0.07%
93282 TC NA NA NA $21 $0 0.49%
93282 26 $43 ($0) ‐0.34% $43 ($0) ‐0.34%
93283 NA NA NA $83 $0 0.05%
93283 TC NA NA NA $24 $0 0.49%
93283 26 $58 ($0) ‐0.13% $58 ($0) ‐0.13%
93284 NA NA NA $91 $0 0.49%
93284 TC NA NA NA $27 $0 0.49%
93284 26 $64 $0 0.49% $64 $0 0.49%
93291 NA NA NA $37 $1 1.49%
93291 TC NA NA NA $15 $0 0.49%
93291 26 $22 $0 2.16% $22 $0 2.16%
93285 NA NA NA $43 $0 0.49%
93285 TC NA NA NA $16 $0 0.49%
93285 26 $27 $0 0.49% $27 $0 0.49%
93290 NA NA NA $32 $1 1.65%
93290 TC NA NA NA $10 $0 0.49%
93290 26 $22 $0 2.16% $22 $0 2.16%
93292 NA NA NA $33 $0 0.49%
93292 TC NA NA NA $11 $0 0.49%
93292 26 $22 $0 0.49% $22 $0 0.49%
93286 NA NA NA $28 $0 0.49%
93286 TC NA NA NA $12 $0 0.49%
93286 26 $16 $0 0.49% $16 $0 0.49%
ICD Programming eval 2 lead
S‐ICD Programming device evaluation (in person)
S‐ICD Interrogation device evaluation (in person)
PM Interrogation in person all lead configurations
PM Programming eval 1 lead
PM Programming eval 2 lead
PM Programming eval 3 lead
ICD interrogation in person all lead configurations
ICD Programming eval 1 lead
ICD Programming eval 3 lead
ILR Innterrogation in person
ILR Programming eval
ICM Interrogation in person
Wearable defib Interrogation in person
PM Peri‐px eval and programming
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 25 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
93287 NA NA NA $37 $0 0.49%
93287 TC NA NA NA $13 $0 0.49%
93287 26 $23 $0 0.49% $23 $0 0.49%
93293 NA NA NA $55 $0 0.49%
93293 TC NA NA NA $39 $0 0.49%
93293 26 $16 $0 0.49% $16 $0 0.49%
93228 Wearable defib mobile telemetry w/phy r&I w/report $27 $0 0.49% $27 $0 0.49%
93294 PM Remote Interrogation 90 days all lead config $35 $0 0.49% $35 $0 0.49%
93295 ICD Remote interrogation 90 days all lead config $69 ($0) ‐0.04% $69 ($0) ‐0.04%
93296 PE‐ Remote data aquisition PM or ICD NA NA NA $26 $0 0.49%
93297 ICM Remote interrogation eval 30 days $27 ($0) ‐0.85% $27 ($0) ‐0.85%
93298 ILR Remote interrogation eval 30 days $27 $0 1.83% $27 $0 1.83%
93299 ICM and ILR Remote interr 30 days, tech $0 $0 NA $0 $0 NA
Electrophysiology Procedures
93462 L hrt cath trnsptl puncture $218 $2 0.82% $218 $2 0.82%
93609 26
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)
$288 ($5) ‐1.73% $288 ($5) ‐1.73%
93613 Intracardiac electrophysiologic 3‐dimensional mapping (add on) $415 $2 0.58% 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
$420 ($7) ‐1.54% $420 ($7) ‐1.54%
93620 26
Comprehensive electrophysiologic evaluation including
insertion and repositioning of multiple electrode catheters with
induction or attempted induction of arrhythmia; with right atrial
pacing and recording, right ventricular pacing and recording, His
bundle recording
$667 ($11) ‐1.64% $667 ($11) ‐1.69%
93621 26with left atrial pacing and recording from coronary sinus or left
atrium (add on)$122 ($2) ‐1.55% $122 ($2) ‐1.55%
93622 26 with left ventricular pacing and recording (add on) $178 ($2) ‐1.11% $178 ($2) ‐1.11%
93623 26Programmed stimulation and pacing after intravenous drug
infusion (add on)$165 ($3) ‐1.87% $165 ($3) ‐1.87%
93644 EP Evaluation of S‐ICD NA NA NA $285 ($20) ‐6.50%
93650
Intracardiac catheter ablation of atrioventricular node function,
atrioventricular conduction for creation of complete heart
block, with or without temporary pacemaker placement
$630 $3 0.43% NA NA NA
ICD Peri‐px eval and programming
TTM rhythm strip pacemaker eval
See page 4 for important information about the uses and limitations of this document.
CPT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
Page 26 of 27 CRV-328302-AA JUL2015
2016
Proposed
In‐Facility
Rate
2016
Proposed
In‐Office
Rate$ $ % $ $ %
Proposed 2016 PFS rates compared to Final 2015 rates effective July 1, 2015
CPT®
Modifier
Abbreviated (Partial) Description
Variance 2016
Proposed vs. 2015
Final
Variance 2016
Proposed vs.
2015 Final
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.
$886 $3 0.37% 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
$1,181 $6 0.52% 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)
$443 $2 0.49% 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
$1,182 $2 0.15% 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)
$443 $3 0.57% NA NA NA
93662 26
Intracardiac echocardiography during therapeutic/diagnostic
intervention, including imaging supervision and interpretation
(add on)
$146 ($3) ‐1.69% $146 ($3) ‐1.69%
BSC currently has no FDA‐approved ablation catheters for the treatment of atrial fibrillation
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.
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
Page 27 of 27 CRV-328302-AA JUL2015
Top Related