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Peripheral IVL
Reimbursement

Going Deep into Peripheral IVL Reimbursement

 

Peripheral IVL has reimbursement in the outpatient, Ambulatory Surgical Centers (ASC) and inpatient setting. To learn more, you can review the information and resources below or connect directly with our dedicated team of Reimbursement Specialists. They're available to answer your questions in real time and help you navigate appropriate billing and coding for Peripheral IVL procedures.

 

 

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.

 

FY2025 Payment Updates for Peripheral IVL and Peripheral Procedures

Effective October 1, 2024

2025 Payment Updates for Peripheral IVL desktop 2025 Payment Updates for Peripheral IVL mobile

 

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

Hospital Outpatient

The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the Hospital Outpatient setting.

2025 Outpatient Payments Peripheral Reimbursement
  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.

Ambulatory Surgery Center

The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the ASC setting.

2025 ASC Payments Peripheral Reimbursement
  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

Possible ICD-10-PCS Codes for IVL Procedures

The table below contains a list of possible ICD 10-PCS codes that may be used to bill for IVL.

ICD 10 PCS Codes ivl chart

Medicare Hospital Inpatient MS-DRGs

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.

Peripheral IVL 2025 Medicare Hospital Inpatient MS DRGs desktop

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.

FAQs

  1. What is the associated supply HCPCS code for the IVL peripheral catheters (Shockwave S4, Shockwave M5+, Shockwave L6, Shockwave E8 & Shockwave Javelin Peripheral IVL Catheter)?

    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.

  2. Do Private/Commercial payers accept the HCPCS procedure codes associated with IVL procedures?

    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.

  3. Are the IVL HCPCS codes all inclusive?

    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.

  4. What codes should physicians use when billing for peripheral procedures that involve IVL?

    There currently are no CPT codes associated with IVL for physician billing purposes, nor has CMS has issued any specific direction regarding physician billing. Providers should refer to standard coding rules associated with the overall procedure.

  5. Do physicians get additional reimbursement for using more than one IVL catheter?

    No, there is no additional physician reimbursement associated with the use of multiple catheters.

Resources

reim cta
Connect with a shockwave Reimbursement specialist
coronary ivl reimbursement page
Coronary Reimbursement Landing Page
reim cta

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