As of January 1, 2022, hospital outpatient payment for peripheral Intravascular Lithotripsy (IVL) has increased for procedures performed above-the-knee. The new payments are applied to procedures in iliac, femoral, and popliteal arteries when IVL is performed by itself or adjunctively with drug coated balloons (DCB), stents, or atherectomy.
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).
The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the Hospital Outpatient setting.
The table below contains a list of possible HCPCS codes that may be used to bill for IVL in the ASC setting.
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.
The table below contains a list of possible ICD 10-PCS codes that may be used to bill for IVL.
The ICD-10 procedure codes listed above group to MS-DRGs 252-254. When other procedures are performed in addition to IVL, other MS-DRGs may apply.
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.
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.
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.
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.
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.