Shockwave Peripheral IVL Reimbursement
Going deep into peripheral IVL reimbursement: Shockwave peripheral IVL has reimbursement in the outpatient, ambulatory surgical center (ASC) and inpatient setting.
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2025 Medicare Inpatient Peripheral Reimbursement Updates
The Medicare Inpatient Prospective Payment System (IPPS) Fiscal Year 2025 (FY2025) final rule contained several payment updates. As compared to the prior year, the new rates associated with the peripheral IVL MS-DRGs 278 and 279 result in a national base payment increase of $4,376 for patients with MCC1 and $395 for patients with CC/none1 for peripheral interventions, effective October 1, 2024.
FY2025 Payment Updates for Peripheral Procedures
Therapies: PTA, DCB, Stent (Covered, BMS, DES)
| MS-DRG | Description | Severity | FY2025 Medicare National Base Payment1 |
| 252 | Other vascular procedures | MCC | $24,413 |
| 253 | CC | $18,169 | |
| 254 | None | $12,450 |
FY2025 Payment Updates for Peripheral IVL
Therapies: IVL
| MR-DRG | Description | Severity | FY2025 Medicare National Base Payment1 |
| 278 | Ultrasound accelerated & other thrombolysis of peripheral vascular structures | MCC | $35,606 |
| 279 | CC/None | $22,804 |
MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities.
*When peripheral procedures include peripheral atherectomy, MS-DRGs 270, 271, and 272 may be used.
1: 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 Outpatient & Ambulatory Surgical Centers
Dedicated Hospital Outpatient and Ambulatory Surgery Center codes and payment are available for IVL performed both above-the-knee (iliac, femoral, and popliteal arteries) and below-the-knee (infrapopliteal arteries).
2025 Rates Effective January 1, 2025
Accordion Section
The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the hospital outpatient setting.
| Code | Description | Medicare 2024 National Payment1 | Medicare 2025 National Payment2 |
| C9764 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy, includes angioplasty within the same vessel(s), when performed | $10,482 | $11,341 |
| C9765 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
| C9766 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
| C9767 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
| C9772 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with Intravascular Lithotripsy, includes angioplasty within the same vessel(s), when performed | $10,482 | $11,341 |
| C9773 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
| C9774 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
| C9775 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed | $16,707 | $17,957 |
1: CMS-1786-FC; Medicare Hospital Outpatient Prospective Payment System (OPPS) Calendar Year 2024 Final Rule.
2: CMS-1809-FC; Medicare Hospital Outpatient Prospective Payment System (OPPS) Calendar Year 2025 Final Rule.
*It is important to note that the C-codes are designed to identify the entire procedure, and not just the IVL catheter, when IVL is performed in revascularization procedures. Hospital and ASC charges for the HCPCS codes should reflect charges for the entire procedure similar to other lower extremity revascularization procedures, including charges associated with the IVL catheter.
The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the ASC setting.
| Code | Description | Medicare 2024 National Payment1 | Medicare 2025 National Payment2 |
| C9764 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy, includes angioplasty within the same vessel(s), when performed | $7,256 | $7,753 |
| C9765 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed | $11,744 | $12,497 |
| C9766 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed | $12,076 | $12,749 |
| C9767 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with Intravascular Lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed | $12,341 | $12,668 |
| C9772 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with Intravascular Lithotripsy, includes angioplasty within the same vessel(s), when performed | $6,672 | $7,574 |
| C9773 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed | $11,402 | $11,636 |
| C9774 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed | $12,051 | $11,882 |
| C9775 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with Intravascular Lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed | $12,216 | $13,115 |
1: CMS-1786-FC; Medicare Hospital Outpatient Prospective Payment System (OPPS) Calendar Year 2024 Final Rule.
2: CMS-1809-FC; Medicare Hospital Outpatient Prospective Payment System (OPPS) Calendar Year 2025 Final Rule.
Hospital Inpatient
Effective October 1, 2020, CMS published new International Classification of Diseases, Tenth Revision, Procedural Coding System (ICD-10-PCS) codes specifically identifying IVL. These codes are used for hospital reporting of inpatient procedures, which are assigned to Medicare-Severity Diagnosis Related Groups (MS-DRGs) for payment for the hospital admission.
2025 Rates Effective October 1, 2025
Accordion Section
The table below contains a list of possible ICD 10-PCS codes that may be used to bill for IVL.
| Code | Description |
| 04FC3ZZ | Fragmentation of right common iliac artery, percutaneous approach |
| 04FE3ZZ | Fragmentation of right internal iliac artery, percutaneous approach |
| 04FH3ZZ | Fragmentation of right external iliac artery, percutaneous approach |
| 04FK3ZZ | Fragmentation of right femoral iliac artery, percutaneous approach |
| 04FM3ZZ | Fragmentation of right popliteal artery, percutaneous approach |
| 04FP3ZZ | Fragmentation of right anterior tibial artery, percutaneous approach |
| 04FR3ZZ | Fragmentation of right posterior tibial artery, percutaneous approach |
| 04FT3ZZ | Fragmentation of right peroneal artery, percutaneous approach |
| 04FD3ZZ | Fragmentation of left common iliac artery, percutaneous approach |
| 04FF3ZZ | Fragmentation of left internal iliac artery, percutaneous approach |
| 04FJ3ZZ | Fragmentation of left external iliac artery, percutaneous approach |
| 04FL3ZZ | Fragmentation of left femoral artery, percutaneous approach |
| 04FN3ZZ | Fragmentation of left popliteal artery, percutaneous approach |
| 04FQ3ZZ | Fragmentation of left anterior tibial artery, percutaneous approach |
| 04FS3ZZ | Fragmentation of left posterior tibial artery, percutaneous approach |
| 04FU3ZZ | Fragmentation of left peroneal artery, percutaneous approach |
| 04FY3ZZ | Fragmentation of lower artery, percutaneous approach |
The peripheral IVL ICD-10-PCS codes listed above group to MS-DRGs 278 and 279. Please see below for FY2025 Medicare National Base Payment updates. When other procedures are performed in addition to IVL, other MS-DRGs may apply.
| MS-DRG | Description | 2025 Medicare National Base Payment1 |
| 278 | Ultrasound accelerated and other thrombolysis of peripheral vascular structures with major complication or comorbidity (MCC) | $35,606 |
| 279 | Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC | $22,804 |
MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities.
1: 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.
Shockwave Peripheral IVL Reimbursement FAQs
Accordion Section
There is no IVL-specific supply code for our peripheral IVL catheters. Generally, it is recommended to use C1725 – Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability), for reporting purposes.
The HCPCS procedure codes associated with IVL were developed by CMS. Private/Commercial payers may not choose to recognize these codes. Appropriated pre-authorization and approval process should be followed prior to the procedure for non-Medicare patients.
Yes, the codes are specific to the use of IVL with and/or without the use of other associated technologies such as stenting, drug coated balloons, or atherectomy. Please refer to our peripheral coding guide for more detailed description of the codes.
There currently are no CPT codes associated with IVL for physician billing purposes, nor has CMS issued any specific direction regarding physician billing. Providers should refer to standard coding rules associated with the overall procedure.
No, there is no additional physician reimbursement associated with the use of multiple catheters.
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.