Payment for Biliary Stent Systems

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.

Hospital Inpatient Payment for Biliary Stent Systems

Hospital Outpatient – Based on APC Classification

Biliary Stent Systems CPT® Code

References

Hospital Inpatient Payment for Biliary Stent Systems

The following table provides the current national average Medicare payment for DRGs associated with biliary system procedures. These payments are effective from October 1, 2008 – September 30, 2009. 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.

If exploration of the bile duct (ERCP/ERP) or cholecystectomy is performed in conjunction with biliary stent systems procedures, the MS-DRG logic changes and different MS-DRGs may apply.

Hospital Outpatient – Based on APC Classification

Please refer to the Other Peripheral Procedures coding page for assignment of CPT code to each APC category

Status Indicators

S - Significant Procedure, not discounted when multiple codes occur

T - Significant Procedure, multiple reduction applies

Biliary Stent Systems CPT® Code

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: October 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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