2022 Medicare Peripheral Reimbursement Updates

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.

2022 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. CY 2021 OPPS Final Rule, Addendum B available at https://www.cms.gov/license/ama?file=/files/zip/2021-nfrm-opps-addenda.zip
2022 Medicare Peripheral Reimbursement Summary

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. Medicare 2021 OPPS Final Rule is available for download here: https://www.cms.gov/files/document/12220-opps-final-rule-cms-1736-fc.pdf
  2. Medicare 2022 OPPS Final Rule is available for download here: https://public-inspection.federalregister.gov/2021-24011.pdf
  3. According to Appendix D1, of the OPPS Payment System for 2021, Status Indicator J1 stands for “Hospital Part B Services Paid Through a Comprehensive APC” with the following payment status:
  4. Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS status indicator of “F”,”G”, “H”, “L” and “U”; ambulance services; diagnostic and screening mammography; rehabilitation therapy services; new technology services; self-administered drugs; all preventive services; and certain Part B inpatientservices.
  5. Appendix D1 is available for download here: [https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates]
  6. Addendum B of the OPPS Payment System for 2021 is available for download here: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
  7. 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
*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 2021 is available for download here: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
  2. 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

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 2022 Hospital Inpatient MS-DRGs

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.

ICD-10 procedure codes listed above group to MS-DRGs 252-254
  1. Source: CMS-1752-F

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

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