Current National Average Medicare Payment for Coronary Interventions
Common Inpatient MS-DRGs for Percutaneous Coronary Interventions
Common Outpatient APCs for Percutaneous Coronary Interventions
Common Physician Payments for Percutaneous Coronary Interventions
Common Inpatient MS-DRGs for Percutaneous Coronary Interventions
The following table provides the current national average Medicare payment for DRGs that are commonly paid for Abbott Vascular products. These payments are effective from October 1, 2007 – September 30, 2008. Actual Medicare payments vary by hospital based on labor costs, medical education programs and disproportionate share allowances. Please consult your local Medicare Fiscal Intermediary for additional information.
|
FY 2008 Medicare Severity Diagnosis Related Groups (MS-DRG) |
FY 08 National Base Payment |
||
|
246 |
Insertion of drug-eluting stent w MCC or 4+ vessels/stents |
$15,647 |
|
|
247 |
Insertion of drug-eluting stent w/o MCC |
$11,450 |
|
|
248 |
Insertion of non-drug-eluting stent w MCC or 4+ vessels/stents |
$13,569 |
|
|
249 |
Insertion of non-drug-eluting stent w/o MCC |
$9,763 |
|
|
250 |
Percutaneous cardiovasc proc w/o coronary artery stent or AMI w/ MCC |
$13,397 |
|
|
251 |
Percutaneous cardiovasc proc w/o coronary artery stent or AMI w/o MCC |
$9,416 |
|
For a list of diagnosis codes Medicare uses to determine complications or comorbidities, or major complications or comorbidities, please click here.
Common Outpatient APCs for Percutaneous Coronary Interventions
The following table provides the current national average Medicare payment for APCs that are commonly paid for Abbott Vascular products. These payments are effective from January 1, 2008 – December 31, 2008. Actual Medicare payments vary by hospital. Please consult your local Medicare Fiscal Intermediary for additional information.
| CY 2008 Ambulatory Procedure Classifications (APC) | CY 08 Payment (National Average) |
| 0083 Coronary angioplasty | $2,891 |
| 0082 Coronary atherectomy | $5,574 |
| 0104 Insertion of non-drug eluting stent in coronary artery | $5,670 |
| 0656 Insertion of drug eluting stent in coronary artery | $7,543 |
Common Physician Payments for Percutaneous Coronary Interventions
The following table provides the current national average Medicare payments for physicians by CPT® codes that are commonly used for Abbott Vascular products. These payments are effective from January 1, 2008 – December 31, 2008. Actual Medicare physician payments vary by geographic location. Please consult your local Medicare Carrier for additional information.
| CPT® Code | CY 08 Payment* (National Average) |
| 92980 Insertion of Coronary Stent, single vessel | $781 |
| 92981 Insertion of Coronary Stent, each additional vessel | $217 |
| 92982 Percuataneous coronary angioplasty, single vessel | $580 |
| 92984 Percutaneous coronary angioplasty, each additional vessel | $155 |
| 92995 Percutaneous coronary atherectomy, single vessel | $637 |
| 92996 Percutaneous coronary atherectomy, each additional vessel | $166 |
*With Budget Neutrality Factor included.
References
Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Regulation # CMS-1533-FC accessed on August 1, 2007 from www.cms.hhs.gov/AcuteInpatientPPS
Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2008 Payment Rates; Regulation # CMS-1392-FC accessed on December 5, 2007 from www.cms.hhs.gov/hospitaloutpatientpps/
Federal Register/ Vol.71, No. 226/Friday, November 24, 2006/ Rules and Regulations http://www.cms.hhs.gov/HospitalOutpatientPPS/
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2008; Regulation # CMS-1385 -FC accessed on December 5, 2007 http://www.cms.hhs.gov/CompetitiveAcquisforBios/Downloads/CMS-1385-FC.pdf
CPT® is a trademark of the American Medical Association.
Current Procedure Terminology (CPT®) is copyright 2005. American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
American Medical Association. Current Procedural Terminology (CPT®) 2005. Professional Edition. Chicago, IL: 2005.
Last updated: June 2008
Disclaimer: The information provided on this website was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content on this website is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct hospitals and/or physicians on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Abbott Vascular assumes will have been made prior to assigning codes or requesting payments. Hospitals and physicians should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures.
This website information represents no promise or guarantee by Abbott Vascular concerning coverage, coding, billing, and payment levels. Abbott Vascular specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website.
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