Shockwave Coronary IVL Reimbursement

Coronary IVL Physician Reimbursement

In calendar year (CY) 2024, The Centers for Medicare & Medicaid Services (CMS) established relative value units (RVUs) and associated payment for Current Procedural Terminology (CPT®)1 +92972, a Category I Add-on code for procedures involving coronary IVL. For CY 2025, CPT® +92972 will continue to provide an additional 2.97 work RVUs and $139 payment in addition to the primary procedure effective January 1, 2025.

Coronary IVL CPT® Add-on Code (+92971)

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 associated with +92972 are in addition to payments associated with the primary procedure.

Impact on Work RVUs When Coronary IVL is Performed¹

Impact on Payment When Coronary IVL is Performed¹

CPT® is a registered trademark of the American Medical Association. Copyright 1995-2024. All rights reserved.
1: Coronary IVL CPT add-on code 92972 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.
2: Primary Procedure Code + Coronary IVL CPT® Add-on Code (92972).
3: CMS-1807-F; Medicare Physician Fee Schedule Calendar Year 2025 Final Rule. 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 Reimbursement

The fiscal year 2025 (FY2025) Medicare National Base Payment Rates associated with the Medicare Severity Diagnosis Related Group (MS-DRG) codes for hospital inpatient coronary IVL and standard PCI procedures are described in the table below and became effective October 1, 2024. As compared to FY2024, National base payments associated with coronary IVL have increased for FY2025. Hospital specific rates will vary.

Increased Hospital Inpatient Payment for Coronary IVL: FY2025 Medicare National Base Payments Effective October 1, 2024

MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities
1: CMS-1785-F; National base MS-DRG rates shown are based on Medicare Inpatient Prospective Payment System FY2024 Final Rule, Table 5. National base 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.
2: CMS-1808-F; National base MS-DRG rates shown are based on Medicare Inpatient Prospective Payment System FY2025 Final Rule, Table 1 & Table 5. National base 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.

Hospital Billing: Key Coding Information for Shockwave Coronary IVL

Hospital Inpatient: The following International Classification of Diseases Procedure Code (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. Please download the Coronary IVL Hospital Inpatient Coding Guide for more information.

Hospital Outpatient: The coronary IVL Healthcare Common Procedure Coding System (HCPCS) Code C1761 and CPT® add-on code +92972 should be billed in combination with a primary procedure code when coronary IVL is performed.

CPT® is a registered trademark of the American Medical Association. Copyright 1995-2024. All rights reserved.

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.