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Payment for Carotid Artery Stenting
Note: Currently, carotid artery stenting is covered and paid only as an inpatient procedure.
Medicare Hospital In-Patient Payment
The hospital inpatient payment system is a prospective payment system (PPS) that classifies patients according to diagnosis, type of treatment, age and other relevant criteria using the ICD-9-CM coding system. Under this system, hospitals normally receive a predetermined payment for treating patients within a particular category or Medicare-Severity Diagnosis-Related Group (MS-DRG).
DRGs are assigned a 'weight' by Medicare. This weight is based on factors which may include comparative use of resources; a patient's admitting diagnosis, procedures performed and complications or co-morbidities. A national average is calculated by CMS and is then adjusted for each hospital based on factors including geography, disproportionate share, and whether or not the institution is a teaching facility.
Note: Medicare hospital inpatient information is effective for the fiscal year (FY) (October 1 through September 30).
| 2012 MS-DRGs and National Base Payment1 | ||
|---|---|---|
| 34 |
Carotid artery stent procedure with major complication or comorbidity |
$19,711 |
| 35 |
Carotid artery stent procedure with complication or comorbidity |
$12,084 |
| 36 |
Carotid artery stent procedure without complication or comorbidity/major complication or comorbidity |
$9,320 |
Medicare Physician Professional Payment
| CPT® | Description | 2011 Base Payment Physician2 |
|---|---|---|
| 37215* |
Transcatheter placement of intravascular stent(s) cervical carotid artery, percutaneous; with distal embolic protection |
$1,167 |
| 37216* |
Transcatheter placement of intravascular stent(s) cervical carotid artery, percutaneous; without distal embolic protection |
Non-covered service, no payment. |
* Bundled codes, include all work done on treatment side (catheter placement, angioplasty, angiography and stent placement).
CMS non-covered service.
1 42 CFR Parts 412, 413, and 476, et al. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and FY2012 Rates; Final Rule, August 1, 2011.
2 42 CFR Parts 405, 409, 410 et al. Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Final Rule, November 29, 2010. Payments based on conversion factor emergency update of $33.9764 for January 1, 2011.
References:
Centers for Medicare and Medicaid Services at http://www.cms.gov
ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2011 Professional; 6th edition; edited by Anita C. Hart, RHIA, CCS, CCS-P, Melinda S. Stegman, MBA, CCS, Beth Ford, RHIT, CCS; Ingenix
CPT® is a trademark of the American Medical Association.
Current Procedure Terminology (CPT®) is copyright 2010. 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®) 2011. Professional Edition. Chicago, IL.
Last updated: October 2011
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