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Peripheral IVL Reimbursement

Going Further into Peripheral IVL Payments

Peripheral IVL has seen significant progress on reimbursement. Peripheral IVL has reimbursement in the outpatient, Ambulatory Surgical Centers (ASC) and inpatient setting. The beginning of 2023 brings further progress with the Medicare payment increases for IVL in the treatment of iliac, femoral, and popliteal arteries in the ASC 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.

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2023 Medicare Peripheral Reimbursement Updates

As of January 1, 2023, Ambulatory Surgical Center payment for peripheral Intravascular Lithotripsy (IVL) has increased for procedures performed above-the-knee. The increased payments are applied to procedures in iliac, femoral, and popliteal arteries when IVL is performed by itself (or adjunctively with drug coated balloons) or with atherectomy.

2023 Medicare Peripheral Reimbursement Updates Chart
  1. Addendum B of the OPPS Payment System for 2022 is available for download here: www.cms.gov/license/ama?file=/files/zip/2022-nfrm-opps-data-addendum-b-and-2-times-rule.zip
  2. Current Procedural Terminology. CPT only copyright 2021 American Medical Association. All rights reserved.
  3. Addendum B of the OPPS Payment System for 2023 is available for download here: https://www.govinfo.gov/content/pkg/FR-2022-11-23/pdf/2022-23918.pdf

Hospital Outpatient & Ambulatory Surgical Centers

Dedicated Hospital Outpatient and Ambulatory Surgery Center codes are available for IVL performed both above-the-knee (iliac, femoral, and popliteal arteries) and below-the-knee (infrapopliteal arteries).

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.

List of possible HCPCS codes that may be used to bill for IVL in the Hospital Outpatient setting.
  1. Addendum B of the OPPS Payment System for 2022 is available for download here: https://www.cms.gov/license/ama?file=/files/zip/2022-nfrm-opps-data-addendum-b-and-2-times-rule.zip
  2. Addendum B of the OPPS Payment System for 2023 is available for download here: https://www.govinfo.gov/content/pkg/FR-2022-11-23/pdf/2022-23918.pdf
*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.

list of possible HCPCS codes that may be used to bill for IVL in the ASC setting.
  1. Addendum B of the OPPS Payment System for 2022 is available for download here: https://www.cms.gov/license/ama?file=/files/zip/2022-nfrm-opps-data-addendum-b-and-2-times-rule.zip
  2. https://www.govinfo.gov/content/pkg/FR-2022-11-23/pdf/2022-23918.pdf

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.

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.

list of possible ICD 10-PCS codes that may be used to bill for IVL

Medicare 2023 Hospital Inpatient MS-DRGs

The ICD-10 procedure codes listed group to MS-DRGs 252-254. When other procedures are performed in addition to IVL, other MS-DRGs may apply.

ICD-10 procedure codes listed above group to MS-DRGs 252-254
  1. CMS-1752-CN; 2CMS-1771-FF

FAQs

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

    There is no HCPCS code that is specific to our peripheral lithotripsy 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

phone and email icons Connect with a shockwave Reimbursement specialist
Comprehensive Peripheral Reimbursement Guide Comprehensive Peripheral Reimbursement Guide
coronary ivl reimbursement page Coronary Reimbursement Landing Page
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