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

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.

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.

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.

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

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.

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

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.

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

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)?

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

Are the IVL HCPCS codes all-inclusive?

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

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

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.

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.

2025 Medicare Inpatient Peripheral Reimbursement Updates

FY2025 Payment Updates for Peripheral Procedures

FY2025 Payment Updates for Peripheral IVL

Hospital Outpatient & Ambulatory Surgical Centers

2025 Rates Effective January 1, 2025

Accordion Section

Hospital Inpatient

2025 Rates Effective October 1, 2025

Accordion Section

Shockwave Peripheral IVL Reimbursement FAQs

Accordion Section