Shockwave IVL Reimbursement

Our goal: To ensure that Shockwave Intravascular Lithotripsy (IVL) is reimbursed at the highest level possible, and with the least amount of up front work for both hospital administrators and physicians.

See Peripheral IVL Reimbursement See Coronary IVL Reimbursement
line icon of a credit card with a medical sign and a dollar sign.

Our Commitment to Reimbursement

Healthcare codes for new technologies are integral for healthcare billing and physician and hospital facilities to get compensated for their procedures such as Intravascular Lithotripsy (IVL). Since 2020, our team has set up our end-user physicians and their patients to allow thousands of procedures to be performed and reimbursed post FDA regulatory clearances and approvals.

Our Reimbursement Journey: How We Got Here 

Our timeline for gaining sufficient CMS CPT, ICD-10 and HOPPS/IP codes as well as TPT coding for coronary use met and exceeded everyone’s expectations. We’re proud to have met ambitious coding timelines for both peripheral and coronary use for coding and reimbursement compensation, and are grateful for the assistance of many physicians, health systems and Centers for Medicare and Medicaid Services. 

Our reimbursement codes have evolved significantly to accommodate our continued growth and to better serve physicians and their patients. Shockwave Medical will continue to deliver on coding, coverage and reimbursement for IVL as we work towards treating more patients that suffer from coronary or peripheral vascular disease and calcified lesions.   

  • The History of Peripheral IVL Reimbursement at Shockwave:

    • March 2020: Applied for new tech APC along with 16 procedural C-codes for peripheral IVL 
    • March 2020: Applied for peripheral IVL ICD-10-PCS codes 
    • May 2020: Approved in proposed rule with DRG assignments of 252-254 
    • June 2020: Via quarterly update, four new peripheral IVL codes approved “any vessel” 
    • July 2020: Requested reassignment of DRGs to 270-272 
    • August 2020: HOPS panel request for four additional codes for below the knee series 
    • November 2020: Final Rule, moved from four peripheral IVL codes to eight C-codes (four above the knee and four below the knee); effective January 1, 2021 
    • January 2022: Outpatient APC codes for three of four above-the-knee procedures moved up a level; above-the-knee and below-the-knee APC assignments are similar 
    • January 2024: Peripheral IVL DRGs reassigned to its own grouping; away for LER procedures including atherectomy 

  • The History of Coronary IVL Reimbursement at Shockwave:

    • February 2021: Coronary IVL approval  
    • May 2021: Proposed rule NTAP approved 
    • June 2021: TPT approved effective July 1; no device offset 
    • October 2021: NTAP effective 
    • July 2022: ACC and SCAI application of 0715T tracking code approved 
    • September 2023: Level 1 add-on code application approved; effective January 1, 2024
    • July 2024: TPT concludes; six-month gap 
    • August 2024: Request for complexity adjustments on coronary IVL code combinations 

Resources

The coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. Shockwave Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies. Amounts reflect the base payment rate before adjustments, including any sequestration or geographic adjustments. Payment rates are updated periodically by CMS, and the above information does not represent a guarantee of coverage or reimbursement.