Payment for Peripheral Interventions

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 Peripheral Interventions
• Hospital Outpatient – Based on APC Classification
• Physician Professional Payment – Based on CPT® Code

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 Administrative Contractor for additional information.

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

Physician Professional Payment – Based on CPT® Code

Payments based on facility relative value unit (RVU) for services provided in inpatient or outpatient hospital settings, emergency rooms, skilled nursing facilities, or ambulatory surgical centers (ASCs).

Non-Coronary Percutaneous Transluminal Angioplasty.

CPT is a registered trademark of the American Medical Association. © 2010 All rights reserved.

Peripheral Stent, Percutaneous

Bundled codes include all work done on treatment side (catheter placement, angioplasty, angiography and stent placement).

*CAUTION: The RX HERCULINK ELITE™ Renal Stent System is an investigational device. Limited by Federal (U.S.) law to investigational use only.

Coverage is limited to procedures performed using FDA-approved carotid artery stents and FDA-approved or -cleared embolic protection devices.

The use of an FDA-approved or cleared embolic protection device is required. If deployment of the embolic protection device is not technically possible, and not performed, then the procedure is not covered by Medicare.

Catheter Placement

Diagnostic Angiography, Radiological S&I, Professional Component (-26 Modifier)

Procedural Radiological S&I, Professional Component (-26 Modifier)

Arteriovenous (AV) Graft/Shunt Procedures

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:

Centers for Medicare and Medicaid Services at: www.cms.gov

ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2011Professional; 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

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.