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Coronary IVL
Reimbursement

Going Deep into Coronary IVL Payments

Since the launch of Coronary IVL in early 2021, Shockwave has made deep and significant progress on reimbursement. To learn more, you can review the information and resources below or connect directly with our dedicated team of Reimbursement Specialists.

Download our coding guides for additional information related to Coronary IVL reimbursement.

 

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Coronary IVL Physician Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has established relative value units (RVUs) and associated Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) payment rates for Current Procedural Terminology (CPT®) code +92972, a Category I Add-on code for procedures involving Coronary IVL. CPT® +92972 provides an additional 2.97 work RVUs and $140 payment in addition to the primary procedure. This code and the associated PFS payment rates are effective January 1, 2024. Prior to the establishment of +92972, there were no additional RVUs or professional fees for performing Coronary IVL.

 

 

Please review the coding guide linked below for additional information related to Coronary IVL physician reimbursement.

Coronary IVL CPT Add On Code table graphic Coronary IVL CPT Add on Code table mobile

CPT® code +92972 is an add-on code that must be used in conjunction with a primary procedure CPT® code. The payment rate for +92972 is in addition to payment for the primary procedure CPT® code and can be used regardless if adjunctive technologies (i.e. atherectomy, PTCA) are used in conjunction with Coronary IVL. Please see the below tables for more information.

Impact on Work RVUs Payment When Coronary IVL Performed table graphic Impact on Work RVUs Payment table mobile

Please review the coding guide linked below for additional information related to Coronary IVL physician reimbursement.

Physician Reimbursement Coding Guide

CPT® is a registered trademark of the American Medical Association. Copyright 1995-2023. All rights reserved.

1: CMS-1784-F; Medicare Physician Fee Schedule Fiscal Year 2024 Final Rule.

2: Payment rates do not take into account geographical or additional adjustments. Providers should contact their local Medicare Administrative Contractor (MAC) or CMS for specific information as payment rates vary by region.

Coronary IVL Hospital
Inpatient Reimbursement

Starting October 1, 2023, three new Coronary IVL-specific Medicare Severity Diagnosis Related Group (MS-DRG) codes have been established for Percutaneous Coronary Intervention (PCI) procedures involving Coronary IVL in the hospital inpatient setting. The New Technology Add-on Payment (NTAP) for Coronary IVL will conclude on September 30, 2023.

 

Additionally, the final 2024 Medicare Inpatient Prospective Payment System (IPPS) rule consolidates the prior four MS-DRGs involving PCI with implant of a stent into two MS-DRGs, removing a previous distinction between stent type – Drug Eluting Stent (DES) or Bare Metal Stent (BMS). PCI with stent procedures utilizing alternative plaque modification therapies such as atherectomy, cutting or scoring balloons without the adjunctive use of IVL will map to PCI MS-DRGs 321-322. Please see the table below for more information.

 

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*Coronary IVL is indicated for use prior to stent implementation

The following ICD-10-PCS codes are specific to procedures involving the use of IVL on one or more coronary arteries. Codes associated with stent procedures as well any other procedures performed may also be applicable. Coronary IVL ICD-10-PCS codes must be billed in order to obtain IVL MS-DRGs.

ICD 10 PCS table ICD 10 PCS table mobile

Please review the coding guide linked below for additional information related to Coronary IVL reimbursement within the hospital inpatient setting.

Coronary IVL Hospital Inpatient Coding Guide

1. MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities.

 

2. CMS-1785-F; National Average MS-DRG rates shown are based on Medicare Inpatient Prospective Payment System FY2024 Final Rule, Table 5. National average payment rates assume full update amount for hospitals which have submitted quality data and hospitals have a wage index greater than 1. Site specific payment rates will vary based on regional area wage differences, teaching hospital status, indirect medical education costs, quality data, additional payments to hospitals that treat a large percentage of low income patients (“disproportionate share payments”), etc.

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