Abbott Vascular Coding and Coverage Resources
Product Information
Specifications
- Product Name: Health Economics & Reimbursement 2024 Reimbursement Guide
- Category: Healthcare Economics
- Manufacturer: Abbott
- Year: 2024
Product Usage Instructions
Overview
The Health Economics & Reimbursement 2024 Reimbursement Guide by Abbott provides information on reimbursement prospects for various healthcare technologies and procedures under the CMS Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule for the year 2024.
Procedure Guidelines
The guide includes tables with common billing scenarios for technologies and procedures such as Cardiac Rhythm Management (CRM), Electrophysiology (EP), and other related procedures. It is essential to refer to the specific Comprehensive Ambulatory Payment Classification (APC) provided by CMS for accurate reimbursement information.
Reimbursement Analysis
Abbott has analyzed the potential impact of payment changes on individual procedures within the Hospital Outpatient Department (HOPD) and ASC care settings. The guide serves as a reference for understanding reimbursement levels and coverage based on the CY2024 rules.
Contact Information
For further details or inquiries, visit Abbott.com or contact the Abbott Health Care Economics team at 855-569-6430 or email AbbottEconomics@Abbott.com.
FAQ
- Q: How often is the reimbursement guide updated?
- A: Abbott will continue to analyze and update the reimbursement guide as necessary based on changes to CMS payment policies.
- Q: Can the guide guarantee specific reimbursement levels?
- A: The guide provides illustrative purposes only and does not guarantee reimbursement levels or coverage due to variations in procedures and APC classifications.
Product Information
CMS Hospital Outpatient (OPPS) and Ambulatory Surgical Center (ASC) Reimbursement Prospectus
The Centers for Medicare & Medicaid Services (CMS) made significant changes to the calendar year 2024 (CY2024) policies and payment levels which impact several procedures utilizing Abbott’s technology and therapy solutions in the Hospital Outpatient Department (HOPD) and Ambulatory Surgical Center (ASC) settings of care. These changes are compounded by the advance of both new and ongoing payment reform initiatives impacting a majority of U.S. healthcare facilities. In this prospectus document, Abbott highlights certain payment policies and new payment rates to healthcare providers who perform services that are now paid differently than in prior years. On November 2, 2023, CMS released the CY2024 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Final Rule, effective for services on January 1, 2024.3,4 For 2024, CMS projects a:
- 3.1% increase in total OPPS payments3
- 3.1% increase in total ASC payments4
We have provided the following tables based on common billing scenarios for various technologies and procedures. This is intended for illustrative purposes only and is not a guarantee of reimbursement levels or coverage. Reimbursement can vary based on the specific procedures being performed, and on the Comprehensive Ambulatory Payment Classification (APC) that CMS has created in the HOPD. Using the CY2024 rules as a reference, Abbott has analyzed the potential impact on payment to individual procedures performed within the HOPD, and in the ASC care setting, which involve our technologies or therapy solutions. We will continue to analyze the potential impact of the changes to CMS payment policies and update this document as necessary. For more information please visit Abbott.com, or contact the Abbott Health Care Economics team at 855-569-6430 or AbbottEconomics@Abbott.com.
Specification
| Hospital Outpatient (OPPS) | Ambulatory Surgery Center (ASC) | ||||||||||
|
Franchise |
Technology |
Procedure |
Primary APC |
CPT‡ Code |
ASC
Complexity Adj. CPT‡ Code |
2023 Reimbursement |
2024 Reimbursement |
% Change |
2023 Reimbursement |
2024 Reimbursement |
% Change |
|
Electrophysiology (EP) |
EP Ablation |
Catheter ablation, AV node | 5212 | 93650 | $6,733 | $7,123 | 5.8% | ||||
| EP study with catheter ablation, SVT | 5213 | 93653 | $23,481 | $22,653 | -3.5% | ||||||
| EP study and catheter ablation, VT | 5213 | 93654 | $23,481 | $22,653 | -3.5% | ||||||
| EP study and catheter ablation, treatment of AF by PVI | 5213 | 93656 | $23,481 | $22,653 | -3.5% | ||||||
| EP Studies | Comprehensive EP study without induction | 5212 | 93619 | $6,733 | $7,123 | 5.8% | |||||
|
Cardiac Rhythm Management (CRM) |
Implantable Cardiac Monitor (ICM) | ICM implantation | 33282 | $8,163 | |||||||
| 5222 | 33285 | $8,163 | $8,103 | -0.7% | $7,048 | $6,904 | -2.0% | ||||
| ICM Removal | 5071 | 33286 | $649 | $671 | 3.4% | $338 | $365 | 8.0% | |||
|
Pacemaker |
System Implant or Replacement – Single Chamber (Ventricular) |
5223 |
33207 |
$10,329 |
$10,185 |
-1.4% |
$7,557 |
$7,223 |
-4.4% |
||
| System Implant or Replacement – Dual Chamber | 5223 | 33208 | $10,329 | $10,185 | -1.4% | $7,722 | $7,639 | -1.1% | |||
| Leadless Pacemaker Removal | 5183 | 33275 | $2,979 | $3,040 | 2.0% | $2,491 | $2,310 | -7.3% | |||
| Leadless Pacemaker Implant | 5224 | 33274 | $17,178 | $18,585 | 8.2% | $12,491 | $13,171 | 5.4% | |||
| Battery Replacement – Single Chamber | 5222 | 33227 | $8,163 | $8,103 | -0.7% | $6,410 | $6,297 | -1.8% | |||
| Battery Replacement – Dual Chamber | 5223 | 33228 | $10,329 | $10,185 | -1.4% | $7,547 | $7,465 | -1.1% | |||
|
Implantable Cardioverter Defibrillator (ICD) |
System Implant or Replacement | 5232 | 33249 | $32,076 | $31,379 | -2.2% | $25,547 | $24,843 | -2.8% | ||
| Battery Replacement – Single Chamber | 5231 | 33262 | $22,818 | $22,482 | -1.5% | $19,382 | $19,146 | -1.2% | |||
| Battery Replacement – Dual Chamber | 5231 | 33263 | $22,818 | $22,482 | -1.5% | $19,333 | $19,129 | -1.1% | |||
| Sub-Q ICD | Insertion of Subcutaneous ICD system | 5232 | 33270 | $32,076 | $31,379 | -2.2% | $25,478 | $25,172 | -1.2% | ||
| Leads Only – Pace- maker, ICD, SICD, CRT | Single lead, Pacemaker, ICD, or SICD | 5222 | 33216 | $8,163 | $8,103 | -0.7% | $5,956 | $5,643 | -5.3% | ||
| CRT | 5223 | 33224 | $10,329 | $10,185 | -1.4% | $7,725 | $7,724 | -0.0% | |||
| Device Monitoring | Programming and Remote Monitoring | 5741 | 0650T | $35 | $36 | 2.9% | |||||
| 5741 | 93279 | $35 | $36 | 2.9% | |||||||
|
CRT-P |
System Implant or Replacement | 5224 | 33208
+ 33225 |
C7539 | $18,672 | $18,585 | -0.5% | $10,262 | $10,985 | 7.0% | |
| Battery Replacement | 5224 | 33229 | $18,672 | $18,585 | -0.5% | $11,850 | $12,867 | 8.6% | |||
|
CRT-D |
System Implant or Replacement | 5232 | 33249
+ 33225 |
$18,672 | $31,379 | -2.2% | $25,547 | $24,843 | -2.8% | ||
| Battery Replacement | 5232 | 33264 | $32,076 | $31,379 | -2.2% | $25,557 | $25,027 | -2.1% | |||
|
Heart Failure |
CardioMEMS | Sensor Implant | C2624 | ||||||||
| 5200 | 33289 | $27,305 | $27,721 | 1.5% | $24,713 | ||||||
| LVAD | Interrogation, in person | 5742 | 93750 | $100 | $92 | -8.0% | |||||
| Advance care planning | 5822 | 99497 | $76 | $85 | 11.8% | ||||||
|
Hypertension |
Renal Denervation |
Renal denervation, unilateral |
5192 |
0338T |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$2,526 |
8.6% |
|
|
Renal denervation, bilateral |
5192 |
0339T |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$3,834 |
64.8% |
|||
| Hospital Outpatient (OPPS) | Ambulatory Surgery Center (ASC) | ||||||||||
|
Franchise |
Technology |
Procedure |
Primary APC |
CPT‡ Code |
ASC
Complexity Adj. CPT‡ Code |
2023 Reimbursement |
2024 Reimbursement |
% Change |
2023 Reimbursement |
2024 Reimbursement |
% Change |
|
Coronary |
PCI Drug Eluting Stents (including FFR/OCT) |
DES, with angioplasty; one vessel, with or without FFR and/or OCT | 5193 | C9600 | $10,615 | $10,493 | -1.1% | $6,489 | $6,706 | 3.3% | |
| Two DES, with angioplasty; two vessels, with or without FFR and/ or OCT. |
5193 |
C9600 |
$10,615 |
$10,493 |
-1.1% |
$6,489 |
$6,706 |
3.3% |
|||
| Two DES, with angioplasty; one vessel, with or without FFR and/ or OCT |
5193 |
C9600 |
$10,615 |
$10,493 |
-1.1% |
$6,489 |
$6,706 |
3.3% |
|||
| Two DES, with angioplasty; two major coronary arteries, with or without FFR and/or OCT. |
5194 |
C9600 |
$10,615 |
$16,725 |
57.6% |
$9,734 |
$10,059 |
3.3% |
|||
| BMS with atherectomy | BMS with atherectomy | 5194 | 92933 | $17,178 | $16,725 | -2.6% | |||||
| DES with atherectomy | DES with atherectomy | 5194 | C9602 | $17,178 | $16,725 | -2.6% | |||||
| DES and AMI | DES and AMI | C9606 | $0 | ||||||||
| DES and CTO | DES and CTO | 5194 | C9607 | $17,178 | $16,725 | -2.6% | |||||
|
Coronary Angiography and Coronary Physiology (FFR/ CFR) or OCT |
Coronary angiography | 5191 | 93454 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | ||
| Coronary angiography + OCT | 5192 | 93454
+ 92978 |
C7516 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography in graft | 5191 | 93455 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Coronary angiography in graft
+ OCT |
5191 | 93455
+ 92978 |
C7518 | $5,215 | $3,108 | -40.4% | $2,327 | ||||
| Coronary angiography in graft + FFR/CFR | 5191 | 93455
+ 93571 |
C7519 | $5,215 | $3,108 | -40.4% | $2,327 | ||||
| Coronary angiography with right heart catherterization | 5191 | 93456 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Coronary angiography with right heart catherterization + OCT | 5192 | 93456
+ 92978 |
C7521 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography with right heart catherterization + FFR/CFR | 5192 | 93456
+ 93571 |
C7522 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography in graft with right heart catheterization | 5191 | 93457 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Coronary angiography in graft with right heart catheterization
+ FFR/CFR |
5191 |
93457
+ 93571 |
$5,215 |
$3,108 |
-40.4% |
$0 |
$0 |
||||
| Coronary angiography with left heart catherization | 5191 | 93458 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Coronary angiography with left heart catherization + OCT | 5192 | 93458
+ 92978 |
C7523 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography with left heart catherization + FFR/CFR | 5192 | 93458
+ 93571 |
C7524 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography in graft with left heart catherization | 5191 | 93459 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Coronary angiography in graft with left heart catherization + OCT | 5192 | 93459
+ 92978 |
C7525 | $5,215 | $5,452 | 4.5% | $2,327 | $2,526 | 8.6% | ||
| Coronary angiography in graft with left heart catherization + FFR/CFR |
5192 |
93459
+ 93571 |
C7526 |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$2,526 |
8.6% |
||
| Cornary angiography with right and left heart catheterization | 5191 | 93460 | $2,958 | $3,108 | 5.1% | $1,489 | $1,633 | 9.7% | |||
| Cornary angiography with right and left heart catheterization
+ OCT |
5192 |
93460
+ 92978 |
C7527 |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$2,526 |
8.6% |
||
| Cornary angiography with right and left heart catheterization + FFR/CFR |
5192 |
93460
+ 93571 |
C7528 |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$2,526 |
8.6% |
||
| Hospital Outpatient (OPPS) | Ambulatory Surgery Center (ASC) | ||||||||||
|
Franchise |
Technology |
Procedure |
Primary APC |
CPT‡ Code |
ASC
Complexity Adj. CPT‡ Code |
2023 Reimbursement |
2024 Reimbursement |
% Change |
2023 Reimbursement |
2024 Reimbursement |
% Change |
|
Coronary |
Coronary Angiography and Coronary Physiology (FFR/ CFR) or OCT |
Coronary angiography in graft with right and left heart catheterization |
5191 |
93461 |
$2,958 |
$3,108 |
5.1% |
$1,489 |
$1,633 |
9.7% |
|
| Coronary angiography in graft with right and left heart catheterization + FFR/CFR |
5192 |
93461
+ 93571 |
C7529 |
$5,215 |
$5,452 |
4.5% |
$2,327 |
$2,526 |
8.6% |
||
|
Peripheral Vascular |
Angioplasty |
Angioplasty (Iliac) | 5192 | 37220 | $5,215 | $5,452 | 4.5% | $3,074 | $3,275 | 6.5% | |
| Angioplasty (Fem/Pop) | 5192 | 37224 | $5,215 | $5,452 | 4.5% | $3,230 | $3,452 | 6.9% | |||
| Angioplasty (Tibial/Peroneal) | 5193 | 37228 | $10,615 | $10,493 | -1.1% | $6,085 | $6,333 | 4.1% | |||
|
Atherectomy |
Atherectomy (Iliac) | 5194 | 0238T | $17,178 | $16,725 | -2.7% | $9,782 | $9,910 | 1.3% | ||
| Atherectomy (Fem/Pop) | 5194 | 37225 | $10,615 | $16,725 | 57.6% | $7,056 | $11,695 | 65.7% | |||
| Atherectomy (Tibial/Peroneal) | 5194 | 37229 | $17,178 | $16,725 | -2.6% | $11,119 | $11,096 | -0.2% | |||
|
Stenting |
Stenting (Iliac) | 5193 | 37221 | $10,615 | $10,493 | -1.1% | $6,599 | $6,772 | 2.6% | ||
| Stenting (Fem/Pop) | 5193 | 37226 | $10,615 | $10,493 | -1.1% | $6,969 | $7,029 | 0.9% | |||
| Stenting (Periph, incl Renal) | 5193 | 37236 | $10,615 | $10,493 | -1.1% | $6,386 | $6,615 | 3.6% | |||
| Stenting (Tibial/Peroneal) | 5194 | 37230 | $17,178 | $16,725 | -2.6% | $11,352 | $10,735 | -5.4% | |||
|
Atherectomy and Stenting |
Atherectomy and stenting (Fem/ Pop) | 5194 | 37227 | $17,178 | $16,725 | -2.6% | $11,792 | $11,873 | 0.7% | ||
| Atherectomy and stenting (Tibial/ Peroneal) | 5194 | 37231 | $17,178 | $16,725 | -2.6% | $11,322 | $11,981 | 5.8% | |||
|
Vascular Plugs |
Venous embolization or occlusion | 5193 | 37241 | $10,615 | $10,493 | -1.1% | $5,889 | $6,108 | 3.7% | ||
| Arterial embolization or occlusion | 5194 | 37242 | $10,615 | $16,725 | 57.6% | $6,720 | $11,286 | 67.9% | |||
| Embolization or occlusion for tumors, organ ischemia, or infarction |
5193 |
37243 |
$10,615 |
$10,493 |
-1.1% |
$4,579 |
$4,848 |
5.9% |
|||
| Embolization or occlusion for arterial or venous hemorrhage or lymphatic extravasation |
5193 |
37244 |
$10,615 |
$10,493 |
-1.1% |
||||||
|
Arterial Mechanical Thrombectomy |
Primary arterial percutaneous mechanical thrombectomy; initial vessel |
5194 |
37184 |
$10,615 |
$16,725 |
57.6% |
$6,563 |
$10,116 |
54.1% |
||
|
Peripheral Vascular |
Primary arterial percutaneous mechanical thrombectomy; second and all subsequent vessel(s) |
37185 |
Packaged |
Packaged |
NA |
NA |
|||||
| Secondary arterial percutaneous mechanical thrombectomy | 37186 | Packaged | Packaged | NA | NA | ||||||
|
Arterial Mechanical Thrombectomy with Angioplasty |
Primary arterial percutaneous mechanical thrombectomy; initial vessel with angioplasty Iliac |
NA |
37184
+37220 |
$8,100 |
$11,754 |
45.1% |
|||||
| Primary arterial percutaneous mechanical thrombectomy; initial vessel with angioplasty fem/pop |
NA |
37184
+37224 |
$8,178 |
$11,842 |
44.8% |
||||||
| Primary arterial percutaneous mechanical thrombectomy; initial vessel with angioplasty tib/pero |
NA |
37184
+37228 |
$9,606 |
$13,283 |
38.3% |
||||||
|
Arterial Mechanical Thrombectomy with Stenting |
Primary arterial percutaneous mechanical thrombectomy; initial vessel with stenting Iliac |
NA |
37184
+37221 |
$9,881 |
$13,502 |
36.7% |
|||||
| Primary arterial percutaneous mechanical thrombectomy; initial vessel with stenting fem/pop |
NA |
37184
+37226 |
$10,251 |
$13,631 |
33.0% |
||||||
| Primary arterial percutaneous mechanical thrombectomy; initial vessel with stenting tib/pero |
NA |
37184
+37230 |
$14,634 |
$15,793 |
7.9% |
||||||
| Hospital Outpatient (OPPS) | Ambulatory Surgery Center (ASC) | ||||||||||
|
Franchise |
Technology |
Procedure |
Primary APC |
CPT‡ Code |
ASC
Complexity Adj. CPT‡ Code |
2023 Reimbursement |
2024 Reimbursement |
% Change |
2023 Reimbursement |
2024 Reimbursement |
% Change |
|
Peripheral Vascular |
Venous Mechanical Thrombectomy |
Venous percutaneous mechanical thrombectomy, initial treatment | 5193 | 37187 | $10,615 | $10,493 | -1.1% | $7,321 | $7,269 | -0.7% | |
| Venous percutaneous mechanical thrombectomy, repeat treatment on subsequent day |
5183 |
37188 |
$2,979 |
$3,040 |
2.0% |
$2,488 |
$2,568 |
3.2% |
|||
| Venous Mechanical Thrombectomy with Angioplasty | Venous percutaneous mechanical thrombectomy, initial treatment with angioplasty |
NA |
37187 + 37248 |
$8,485 |
$8,532 |
0.6% |
|||||
| Venous Mechanical Thrombectomy with Stenting | Venous percutaneous mechanical thrombectomy, initial treatment with stenting |
NA |
37187 + 37238 |
$10,551 |
$10,619 |
0.6% |
|||||
|
Dialysis Circuit Thrombectomy |
Percutaneous mechanical thrombectomy, dialysis circuit | 5192 | 36904 | $5,215 | $5,452 | 4.5% | $3,071 | $3,223 | 4.9% | ||
| Percutaneous mechanical thrombectomy, dialysis circuit, with angioplasty |
5193 |
36905 |
$10,615 |
$10,493 |
-1.1% |
$5,907 |
$6,106 |
3.4% |
|||
| Percutaneous mechanical thrombectomy, dialysis circuit, with stent |
5194 |
36906 |
$17,178 |
$16,725 |
-2.6% |
$11,245 |
$11,288 |
0.4% |
|||
|
Thrombolysis |
Transcatheter arterial thrombolysis treatment, initial day |
5184 |
37211 |
$5,140 |
$5,241 |
2.0% |
$3,395 |
$3,658 |
7.7% |
||
| Transcatheter venous thrombolysis treatment, initial day |
5183 |
37212 |
$2,979 |
$3,040 |
2.0% |
$1,444 |
$1,964 |
36.0% |
|||
| Transcatheter arterial or venous thrombolysis treatment, subsequent day |
5183 |
37213 |
$2,979 |
$3,040 |
2.0% |
||||||
| Transcatheter arterial or venous thrombolysis treatment, final day | 5183 | 37214 | $2,979 | $3,040 | 2.0% | ||||||
|
Structural Heart |
PFO Closure | ASD/PFO closure | 5194 | 93580 | $17,178 | $16,725 | -2.6% | ||||
| ASD | ASD/PFO closure | 5194 | 93580 | $17,178 | $16,725 | -2.6% | |||||
| VSD | VSD closure | 5194 | 93581 | $17,178 | $16,725 | -2.6% | |||||
| PDA | PDA closure | 5194 | 93582 | $17,178 | $16,725 | -2.6% | |||||
|
Chronic Pain |
Spinal Cord Stimulation and DRG Stimulation |
Single Lead Trial: percutaneous | 5462 | 63650 | $6,604 | $6,523 | -1.2% | $4,913 | $4,952 | 0.8% | |
| Dual Lead Trial: percutaneous | 5462 | 63650 | $6,604 | $6,523 | -1.2% | $9,826 | $9,904 | 0.8% | |||
| Surgical Lead Trial | 5464 | 63655 | $21,515 | $20,865 | -3.0% | $17,950 | $17,993 | 0.2% | |||
| Full System – Single lead – Percutaneous | 5465 | 63685 | $29,358 | $29,617 | 0.9% | $29,629 | $30,250 | 2.1% | |||
| Full System – Dual Lead – Percutaneous | 5465 | 63685 | $29,358 | $29,617 | 0.9% | $34,542 | $35,202 | 1.9% | |||
| Full System IPG – Laminectomy | 5465 | 63685 | $29,358 | $29,617 | 0.9% | $42,666 | $43,291 | 1.5% | |||
| IPG implant or replacement | 5465 | 63685 | $29,358 | $29,617 | 0.9% | $24,716 | $25,298 | 2.4% | |||
| Single lead | 5462 | 63650 | Packaged | Packaged | $4,913 | $4,952 | 0.8% | ||||
| Dual lead | 5462 | 63650 | Packaged | Packaged | $4,913 | $4,952 | 0.8% | ||||
| Analysis of IPG, Simple Programming | 5742 | 95971 | $100 | $92 | -8.0% | ||||||
|
Peripheral Nerve Stimulation |
Full System – Single lead – Percutaneous | 5464 | 64590 | $21,515 | $20,865 | -3.0% | $19,333 | $19,007 | -1.7% | ||
| 5462 | 64555 | $6,604 | $6,523 | -1.2% | $5,596 | $5,620 | 0.4% | ||||
| Full System – Dual Lead – Percutaneous | 5464 | 64590 | $21,515 | $20,865 | -3.0% | $19,333 | $19,007 | -1.7% | |||
| 5462 | 64555 | $6,604 | $6,523 | -1.2% | $5,596 | $5,620 | 0.4% | ||||
| IPG replacement | 5464 | 64590 | $21,515 | $20,865 | -3.0% | $19,333 | $19,007 | -1.7% | |||
| Hospital Outpatient (OPPS) | Ambulatory Surgery Center (ASC) | ||||||||||
|
Franchise |
Technology |
Procedure |
Primary APC |
CPT‡ Code |
ASC
Complexity Adj. CPT‡ Code |
2023 Reimbursement |
2024 Reimbursement |
% Change |
2023 Reimbursement |
2024 Reimbursement |
% Change |
|
Chronic Pain |
RF Ablation |
Cervical Spine / Thoracic Spine | 5431 | 64633 | $1,798 | $1,842 | 2.4% | $854 | $898 | 5.2% | |
| Lumbar Spine | 5431 | 64635 | $1,798 | $1,842 | 2.4% | $854 | $898 | 5.2% | |||
| Other Peripheral Nerves | 5443 | 64640 | $852 | $869 | 2.0% | $172 | $173 | 0.6% | |||
| Radiofrequency Ablation | 5431 | 64625 | $1,798 | $1,842 | 2.4% | $854 | $898 | 5.2% | |||
|
Movement Disorders |
DBS |
IPG Placement – Single Array | 5464 | 61885 | $21,515 | $20,865 | -3.0% | $19,686 | $19,380 | -1.6% | |
| IPG Placement – Two Single Array IPGs | 5464 | 61885 | $21,515 | $20,865 | -3.0% | $19,686 | $19,380 | -1.6% | |||
| 5464 | 61885 | $21,515 | $20,865 | -3.0% | $19,686 | $19,380 | -1.6% | ||||
| IPG Placement – Dual Array | 5465 | 61886 | $29,358 | $29,617 | 0.9% | $24,824 | $25,340 | 2.1% | |||
| Analysis of IPG, No Programming | 5734 | 95970 | $116 | $122 | 5.2% | ||||||
| Analysis of IPG, Simple Programming; first 15 Min | 5742 | 95983 | $100 | $92 | -8.0% | ||||||
| Analysis of IPG, Simple Programming; additional 15 Min | 95984 | $0 | |||||||||
Disclaimer
This material and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently and is subject to change without notice. The customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided orauthorized for marketing use.
Sources
- Hospital Outpatient Prospective Payment-Final Rule with Comment CY2024:
- Ambulatory Surgical Center Payment-Final Rule CY2024 Payment Rates:
- Hospital Outpatient Prospective Payment-Final Rule with Comment CY2023:
- Ambulatory Surgical Center Payment-Final Rule CY2023 Payment Rates: https://www.cms.gov/medicaremedicare-fee-service-paymentascpaymentasc-regulations-and-notices/cms-1772-fc
CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at vascular.eifu.abbott or at manuals.eifu.abbott for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events. Abbott One St. Jude Medical Dr., St. Paul, MN 55117, USA, Tel: 1 651 756 2000 ™ Indicates a trademark of the Abbott group of companies. ‡ Indicates a third party trademark, which is property of its respective owner.
©2024 Abbott. All rights reserved. MAT-1901573 v6.0. Item approved for U.S. use only. HE&R approved for non-promotional use only.
Documents / Resources
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Abbott Vascular Coding and Coverage Resources [pdf] Owner's Manual Vascular Coding and Coverage Resources, Coding and Coverage Resources, Coverage Resources, Resources |