Shockwave IVL Reimbursement

CMS Issues New Outpatient and Inpatient Codes for Peripheral Intravascular Lithotripsy (IVL)

The Centers for Medicare & Medicaid Services (CMS) has issued new codes for IVL procedures performed in peripheral arteries in both the hospital outpatient and inpatient settings. The new Healthcare Common Procedure Coding System (HCPCS) outpatient and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) inpatient codes will go into effect on July 1 and October 1, 2020, respectively.

Hospital Outpatient

In the July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS), CMS published four new Level II HCPCS codes describing certain peripheral procedures using intravascular lithotripsy (IVL) for billing in the hospital outpatient setting.

CPT Code Description
c9764 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed
c9765 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
c9766 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, and atherectomy, includes angioplasty within the same vessel(s), when performed
c9767 Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed

It is important to note that these C-codes are designed to identify the entire procedure, and not just the IVL catheter, when IVL is performed in revascularization procedures.  Hospital charges for these four HCPCS codes therefore should reflect charges for the entire procedure similar to other lower extremity revascularization procedures, including the charges associated with the IVL catheter.

Hospital Inpatient

In the 2021 IPPS Rule, CMS has published new International Classification of Diseases, Tenth Revision, Procedural Coding System (ICD-10-PCS) codes specifically identifying IVL, to be effective October 1, 2020.

CPT Code Description
04fc3zz Fragmentation of Right Common Iliac Artery, Percutaneous Approach
04FD3ZZ Fragmentation of Left Common Iliac Artery, Percutaneous Approach
04FE3ZZ Fragmentation of Right Internal Iliac Artery, Percutaneous Approach
04FF3ZZ Fragmentation of Left Internal Iliac Artery, Percutaneous Approach
04FH3ZZ Fragmentation of Right External Iliac Artery, Percutaneous Approach
04FJ3ZZ Fragmentation of Left External Iliac Artery, Percutaneous Approach
04FK3ZZ Fragmentation of Right Femoral Artery, Percutaneous Approach
04FL3ZZ Fragmentation of Left Femoral Artery, Percutaneous Approach
04FM3ZZ Fragmentation of Right Popliteal Artery, Percutaneous Approach
04FN3ZZ Fragmentation of Left Popliteal Artery, Percutaneous Approach
04FP3ZZ Fragmentation of Right Anterior Tibial Artery, Percutaneous Approach
04FQ3ZZ Fragmentation of Left Anterior Tibial Artery, Percutaneous Approach
04FR3ZZ Fragmentation of Right Posterior Tibial Artery, Percutaneous Approach
04FS3ZZ Fragmentation of Left Posterior Tibial Artery, Percutaneous Approach
04FT3ZZ Fragmentation of Right Peroneal Artery, Percutaneous Approach
04FU3ZZ Fragmentation of Left Peroneal Artery, Percutaneous Approach
04FY3ZZ Fragmentation of Lower Artery , Percutaneous Approach

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.

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