Payment for Peripheral Interventions
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Hospital Inpatient Payment for Peripheral Interventions
Hospital Outpatient – Based on APC Classification
Physician Professional Payment – Based on CPT® Code
Peripheral Stent / Shunt Placement, Percutaneous
Diagnostic Angiography, Radiological S&I
Hospital Inpatient Payment for Peripheral Interventions
Peripheral procedures, based on diagnosis code and procedure code may track to one of the following MS-DRGs. 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 |
||
|
252 |
Other vascular procedures w MCC |
$14,849 |
|
|
253 |
Other vascular procedures w CC |
$12,142 |
|
|
254 |
Other vascular procedures w/o CC/MCC |
$9,043 |
|
Hospital Outpatient – Based on APC Classification
Please refer to the Other Peripheral Procedures coding page for assignment of CPT code to each APC category
|
APC |
Status Indicator |
Description |
2008 Base Payment |
|
0083 |
T |
Non-coronary angioplasty or atherectomy |
$2,891 |
|
0082 |
T |
Coronary or non-coronary atherectomy |
$5,574 |
|
0668 |
S |
Level I diagnostic angiography and venography, angioplasty and atherectomy except extremity |
$596 |
|
0279 |
S |
Level II angiography and venography except extremity (S&I) |
$1839 |
|
0280 |
S |
Level III diagnostic angiography and venography except extremity (S&I) |
$2,847 |
Status Indicators
S - Significant Procedure, not discounted when multiple codes occur
T - Significant Procedure, multiple reduction applies
Physician Professional Payment – Based on CPT® Code
Non-Coronary Percutaneous Transluminal Angioplasty
CPT is a registered trademark of the American Medical Association. © 2006 All rights reserved.
|
CPT |
Description |
2008 Base Physician Professional Payment |
|
35470 |
Tibioperoneal trunk or branches, each vessel |
$433 |
|
35471 |
Renal or visceral artery (non-aorta) |
$512 |
|
35473 |
Iliac |
$307 |
|
35474 |
Femoral-popliteal |
$370 |
|
35475 |
Brachiocephalic trunk or branches, each vessel |
$462 |
|
35476 |
Venous |
$295 |
Peripheral Stent / Shunt Placement, Percutaneous
CPT |
Description |
2008 Base Physician Professional Payment |
37205 |
Transcatheter placement of an intravascular stent(s) |
$421 |
+ 37206 |
Each additional vessel |
$202 |
37215* |
Transcatheter placement of intravascular stent(s) cervical carotid artery, percutaneous; with distal embolic protection |
$1,025 |
37216* 1 |
Transcatheter placement of intravascular stent(s) cervical carotid artery, percutaneous; without distal embolic protection |
Non covered, no payment |
* Bundled codes include all work done on treatment side (catheter placement, angioplasty, angiography and stent placement).1 CMS non-covered service. |
||
Catheter Placement
CPT |
Description |
2008 Base Physician Professional Payment |
36215 |
Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family |
$227 |
36216 |
Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family |
$256 |
36217 |
Selective catheter placement, arterial system; initial third order thoracic or brachiocephalic branch, within a vascular family |
$307 |
+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) |
$49 |
36245 |
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch within a vascular family |
$234 |
36246 |
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch within a vascular family |
$257 |
36247 |
Selective catheter placement, arterial system; initial third order abdominal, pelvic, or lower extremity artery branch within a vascular family |
$306 |
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) |
$49 |
Diagnostic Angiography, Radiological S&I
CPT |
Description |
2008 Base Physician Professional Payment |
75650 |
Angiography, cervicocerebral, catheter, including vessel origin, radiological S&I |
$71 |
75658 |
Angiography, brachial, retrograde, radiological S&I |
$63 |
75660 |
Angiography, external carotid, unilateral, selective, radiological S&I |
$63 |
75662 |
Angiography, external carotid, bilateral, selective, radiological S&I |
$80 |
75665 |
Angiography, carotid cerebral, unilateral, selective, radiological S&I |
$63 |
75671 |
Angiography, carotid cerebral, bilateral, selective, radiological S&I |
$79 |
75676 |
Angiography, carotid cervical, unilateral, selective, radiological S&I |
$63 |
75680 |
Angiography, carotid cervical, bilateral, selective, radiological S&I |
$79 |
75685 |
Angiography, vertebral, cervical, and/or intracranial, radiological S&I |
$63 |
75710 |
Angiography, extremity, unilateral, radiological S&I |
$55 |
75716 |
Angiography, extremity, bilateral, radiological S&I |
$62 |
75722 |
Angiography, renal, unilateral, selective (including flush aortogram), radiological S&I |
$56 |
75724 |
Angiography, renal, bilateral, selective (including flush aortogram), radiological S&I |
$75 |
75726 |
Angiography, visceral, selective or supraselective, (with or without flush aortogram), radiological S&I |
$54 |
75736 |
Angiography, pelvic, selective or supraselective, radiological S&I |
$54 |
75790 |
Angiography, AV shunt, radiological S&I |
$86 |
+ 75774 |
Angiography, selective, each additional vessel after basic exam, radiological S&I (list separately in addition to code for primary procedure) |
$17 |
Procedural Radiological S&I
|
CPT |
Description |
2008 Base Physician Professional Payment |
|
75960 |
Transcatheter introduction of intravascular stent(s), (except coronary, carotid and vertebral vessels), percutaneous and/or open, radiological S&I |
$40 |
|
75962 |
Transluminal balloon angioplasty, peripheral artery, radiological S&I |
$26 |
|
+75964 |
Transluminal balloon angioplasty, each additional peripheral artery, radiological S&I (list separately in addition to code for primary procedure) |
$17 |
|
75966 |
Transluminal balloon angioplasty, renal or other visceral artery, radiological S&I |
$64 |
|
+75968 |
Transluminal balloon angioplasty, each additional visceral artery, radiological S&I (list separately in addition to code for primary procedure) |
$18 |
|
75978 |
Transluminal balloon angioplasty, venous, radiological S&I |
$25 |
|
75992 |
Transluminal atherectomy, peripheral artery, radiological S&I |
$27 |
|
+75993 |
Transluminal Atherectomy, each additional peripheral artery, radiological S&I (list separately in addition to code for primary procedure) |
$17 |
|
75994 |
Transluminal atherectomy, renal artery, radiological S&I |
$64 |
|
75995 |
Transluminal atherectomy, visceral artery, radiological S&I |
$62 |
|
+75996 |
Transluminal Atherectomy, each additional visceral artery, radiological S&I (list separately in addition to code for primary procedure) |
$17 |
References:
Centers for Medicare and Medicaid Services at: www.cms.hhs.gov
Centers for Medicare and Medicaid Services at: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-22136.pdf
ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2006 Professional; 6th edition; edited by Anita C. Hart, RHIA, CCS, CCS-P, Catherine A. Hopkins, Beth Ford, RHIT, CCS; Ingenix
CPT® is a trademark of the American Medical Association.
Current Procedure Terminology (CPT®) is copyright 2006. 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®) 2006. Professional Edition. Chicago, IL: 2006.
Last Updated: April 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 and policies. 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 medical providers 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. Medical providers 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 represents no promise or guarantee by Abbott Vascular regarding 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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