Shockwave Coronary IVL Reimbursement

Coronary IVL Physician Coding and Reimbursement

For calendar year 2026 (CY2026), The Centers for Medicare & Medicaid Services (CMS) has assigned CPT® code +92972 – a Category I Add-on code for procedures involving Coronary IVL – a total relative value unit (RVU) of 3.66 and a work related RVU value of 2.90. Based on the assigned total RVUs, the national Medicare physician facility payment is $122. These RVUs and physician payments for +92972 are effective January 1, 2026.

Coronary IVL CPT® Code +92972 in CY2026

*Physician Facility Payment is based on Total RVUs

Application & Impact of Coronary IVL CPT Code +92972

The tables below provide examples of how utilizing Coronary IVL and reporting CPT® code +92972 in conjunction with a primary procedure code impacts the total work RVUs and physician facility payment associated with a procedure.

CPT® code +92972 is an add-on code and may be used with all primary CPT® codes for PCI. For a complete description of appropriate use of +92972, please refer to the most current edition of the CPT® codebook from AMA CPT® Editorial Panel. The tables below describe the impact that +92972 has on the primary PCI procedure codes with which Coronary IVL is most frequently utilized. The RVUs and payment associated with +92972 are in addition to payments associated with the primary procedure.

Impact on Work RVUs When Shockwave Coronary IVL is Performed

*Coronary IVL is indicated for use prior to stent implantation.

Impact on Payment When Shockwave Coronary IVL is Performed

*Coronary IVL is indicated for use prior to stent implantation.

CPT® 2025 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association
1. CMS-1832-F; Medicare Physician Fee Schedule, MPFS, Calendar Year 2026 Final Rule. 10/31/25, Addendum B, using conversion factor $33.4009. Additional physician facility payment is based on total RVUs.
2. National payment rates listed utilized conversion factor of $33.4009. These rates do not factor in geographical or additional adjustments. Providers should contact their local Medicare Administrative Contractor for specific payment information.

Coronary IVL Hospital Coding and Reimbursement

Hospital Inpatient Coding & Payments for Coronary IVL

Medicare reimburses acute inpatient care under the FY2026 IPPS, which utilizes the MS-DRG system for payment. When Coronary IVL is performed in the hospital inpatient setting, the hospital discharge is typically assigned to one of the MS-DRGs listed below. Performance of additional procedures may change the MS-DRG assignment. The below FY2026 payments are effective as of October 1, 2025.

Hospital Outpatient Coding & Payments for Coronary IVL

The Centers for Medicare and Medicaid Services (CMS) reimburses hospital outpatient departments using Ambulatory Payment Classification assignments (APCs). As part of the 2026 Final Rule, the Coronary IVL Healthcare Common Procedure Coding System (HCPCS) code C1761 and CPT® add-on code +92972 should be billed in combination with a designated primary procedure code when Coronary IVL is performed. A list of primary procedure codes commonly used with Coronary IVL can be found below. Payment rates for these designated APCs are intended to provide payment under the OPPS for complete services or procedures and are effective January 1, 2026.

Primary CPT^® Procedure Codes Commonly Used with Coronary IVL

CPT® 2025 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
1. CMS-1834-FC, Addenda D1, J1 = Comprehensive APC, All covered services on the claim are packaged with the primary “J1” service on the claim.

Third party reimbursement amounts for specific procedures will vary by payer and by locality. This information is current as of November 2025 but is subject to change without notice. Amounts do not reflect any subsequent changes in payment since publication. To confirm reimbursement rates, you should consult with your local MAC for specific codes. Providers should select the most appropriate HCPCS code(s) with the highest level of detail to describe the service(s) rendered to the patient. Any questions should be directed to the pertinent local payer.

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.