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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 – September 30. Actual Medicare payments vary by hospital based on labor costs, medical education programs and disproportionate share allowances. Please consult your local Medicare Administrative Contractor for additional information.
|
FY 2012 Medicare Severity Diagnosis Related Groups (MS-DRG) | FY 12 National Base Payment1 | |
|---|---|---|
| 246 |
Percutaneous cardiovascular procedure with drug-eluting stent with major complication or comorbidity or 4+ vessels/stents |
$17,866 |
| 247 |
Percutaneous cardiovascular procedure with drug-eluting stent without major complication or comorbidity |
$11,165 |
| 248 |
Percutaneous cardiovascular procedure with non-drug-eluting stent with major complication or comorbidity or 4+ vessels/stents |
$16,553 |
| 249 |
Percutaneous cardiovascular procedure with non-drug-eluting stent without major complication or comorbidity |
$10,210 |
| 250 |
Percutaneous cardiovascular procedure without coronary artery stent or acute myocardial infarction (AMI) with major complication or comorbidity |
$16,286 |
| 251 |
Percutaneous cardiovascular procedure without coronary artery stent or acute myocardial infarction (AMI) without major complication or comorbidity |
$10,388 |
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– December 31. Actual Medicare payments vary by hospital. Please consult your local Medicare Fiscal Intermediary for additional information.
|
CY 2011 Ambulatory Procedure Classifications (APC) | CY 11 Payment (National Average)2 |
|
|---|---|---|
| 0083 | Coronary or Non-Coronary Angioplasty and Percutaneous Valvuloplasty | $3,780 |
| 0104 | Transcatheter Placement of Intracoronary Stents | $5,656 |
| 0656 | Transcatheter Placement of Intracoronary Drug-Eluting Stents | $7,279 |
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, 2011 – December 31, 2011. Actual Medicare physician payments vary by geographic location. Please consult your local Medicare Carrier for additional information.
|
CPT® Code | CY 11 Payment* (National Average)3 |
|
|---|---|---|
| 92980 | Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel | $873 |
| 92981 | Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel | $243 |
| 92982 | Percutaneous transluminal coronary balloon angioplasty, single vessel | $647 |
| 92984 | Percutaneous transluminal coronary balloon angioplasty, each additional vessel | $173 |
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 410, 411, 412, et al.Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Final Rule, November 24, 2010.
3 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
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
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.