IMPULSE DYNAMICS Implantable Optimizer Smart System

Specifications

• Product Name: Cardiac Contractility Modulations implants
• Usage: Treatment of heart failure

Product Usage Instructions

CPT Codes

• 0408T – Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator with transvenous electrodes
• 0409T – Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only

Medicare National Average Payment:

• 0408T – $32,062
• 0409T – $8,276

Frequently Asked Questions (FAQ)

• Q: How do I find payment information for CCM implants?
  
  • A: Physician Billing CCM implants are described by Category III CPT codes. Please refer to your Medicare Administrative Contractor’s website or contact Impulse Dynamics for specific payment information in your jurisdiction.
• Q: How can I submit additional questions?
  
  • A: Additional questions can be submitted to reimbursement@impulse-dynamics.com.

This coding and reimbursement resource is designed to provide information for appropriate billing of Cardiac Contractility Modulations implants for the treatment of heart failure.
Additional questions may be submitted to reimbursement@impulse-dynamics.com

Physician, Outpatient Hospital and Ambulatory Surgery Center Coding
The following CPT Codes, Ambulatory Payment Classifications (APC), status indicators, and national average payments are provided for commonly reported CCM procedure billing physicians, hospital outpatient departments or ambulatory surgery centers.

Product Information

Outpatient Facility Billing
Category III CPT codes are used to designate procedures utilizing emerging technologies. Although Optimizer® Smart received FDA approval on March 21, 2019 under the FDA’s Breakthrough Device designation, the AMA and has yet to issue Category I CPT codes for CCM.

Until Category I CPT codes are issued, payers may continue to perceive the Category III CPT codes associated with CCM as representing investigational or experimental procedures. While this document indicates accurate mapping to APCs, providers and their facility partners should pursue prior authorization before scheduling or conducting CCM implant procedures to ensure payers will not withhold payment. For assistance with prior authorization and appeals, visit www.impulse-dynamics.com/reimbursement

Physician Billing

• CCM implants are described by Category III CPT codes. By definition, such codes are not assigned permanent RVU values by the AMA. Several Medicare Administrative Contractors (MACs) have assigned payment values to these CPT codes. Please refer to your MAC’s website or contact Impulse Dynamics for information on payment in your specific contractor’s jurisdiction.
• When performing CCM implants in MAC jurisdictions in which payment values have not been assigned or for non-Medicare payors, physicians submitting a claim for the CCM implant are advised to reference an existing service or procedure comparable to the CCM implant procedure in terms of costs and resources. A list of possible Category I CPT reference codes is shown on the following page. For more detailed information on use of reference codes for CCM procedures, please consult the Impulse Dynamics CPT Crosswalk Guidance.
• Medicare assigned XXX (global concept does not apply) to all ten codes applicable to CCM procedures; leaving payment to the discretion of the applicable MAC.

CPT Code1          Description                                                                                                      Total RVUs  Work  RVUs

33207	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular	14.09	7.80
33208	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular	15.25	8.52
33212	Insertion of pacemaker pulse generator only; with existing single lead	9.55	5.01
33213	Insertion of pacemaker pulse generator only; with existing dual leads	10.00	5.28
33221	Insertion of pacemaker pulse generator only; with existing multiple leads	10.56	5.55
33228	Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system	10.47	5.52
33230	Insertion of implantable defibrillator pulse generator only; with existing dual leads	11.05	6.07
33249	Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber	26.85	14.92
REMOVAL PROCEDURES
33233	Removal of permanent pacemaker pulse generator only	6.92	3.14
33235	Removal of transvenous pacemaker electrode(s); dual lead system	18.77	9.90
33241	Removal of implantable defibrillator pulse generator only	6.37	3.04
33244	Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction	25.44	13.74
REPOSITIONING PROCEDURES
33215	Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or rightventricular) electrode	9.17	4.92
33222	Relocation of skin pocket for pacemaker	10.18	4.85
33223	Relocation of skin pocket for implantable defibrillator	12.09	6.30
PROGRAMMING/EVALUATION PROCEDURES
	Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of
93280	the device and select optimal permanent programmed values with analysis, review and report by a physician or other	2.35	0.77
	qualified health care professional; dual lead pacemaker system
	Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health
93288	care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple	1.23	0.43
	pacemaker system
	Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care
93289	professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead	1.36	0.75
	transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements
	Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of
93283	the device and select optimal permanent programmed values with analysis, review and report by a physician or other	2.91	1.15
	qualified health care professional; dual lead transvenous implantable defibrillator system

One or more of these comparisons might be provided in claims submission to help determine appropriate reimbursement for these procedures. Each provider must determine the most appropriate reference code. These are examples only, not an exhaustive or definitive list. The medical record should include physician documentation to support the rationale for the code being referenced as comparable, such as service time and skill level, implant approach, and other pertinent information that supports comparison to the code referenced for payment. Physicians must bill the Category III code for CCM, and not the referenced code. The Medicare contractor or commercial payer will likely ask for a copy of the record in order to make a payment decision.

Inpatient Hospital Procedure Reporting
The following ICD-10-CM (diagnosis) codes, ICD-10-PCS (procedure) codes, and DRG definitions are provided for commonly reported CCM procedures in the inpatient hospital setting.

ICD-10-CM Code3

POTENTIAL HEART FAILURE DIAGNOSIS CODES

CC

MCC

I50.10	Left ventricular failure, unspecified	X
I50.20	Unspecified systolic (congestive) heart failure	X
I50.21	Acute systolic (congestive) heart failure		X
I50.22	Chronic systolic (congestive) heart failure	X
I50.23	Acute on chronic systolic (congestive) heart failure	X
I50.30	Unspecified diastolic (congestive) heart failure	X
I50.31	Acute diastolic (congestive) heart failure		X
I50.32	Chronic diastolic (congestive) heart failure	X
I50.33	Acute on chronic diastolic (congestive) heart failure		X
I50.40	Unspecified combined systolic (congestive and diastolic (congestive) heart failure	X
I50.41	Acute combined systolic (congestive) and diastolic (congestive) heart failure		X
I50.42	Chronic combined systolic (congestive) and diastolic (congestive) heart failure	X
I50.43	Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure		X
I50.80	Other heart failure
I50.810	Right heart failure, unspecified
I50.811	Acute right heart failure
I50.812	Chronic right heart failure
I50.813	Acute on chronic right heart failure
I50.814	Right heart failure due to left heart failure
I50.82	Biventricular heart failure
I50.83	High output heart failure
I50.84	End stage heart failure
I50.89	Other heart failure
I50.90	Heart failure, unspecified

ICD-10-PCS4

INSERTION/REPLACEMENT PROCEDURES

• 0JH60AZ Insertion of Contractility Modulation Device into Chest Subcutaneous Tissue and Fascia, Open Approach
• 0JH63AZ Insertion of Contractility Modulation Device into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
• 0JH80AZ Insertion of Contractility Modulation Device into Abdomen Subcutaneous Tissue and Fascia, Open Approach
• 0JH83AZ Insertion of Contractility Modulation Device into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
• 02H63MZ Insertion of cardiac lead into right atrium, percutaneous approach (when specified as a lead for a contractility modulation device)
• 02HK3MZ Insertion of cardiac lead into right ventricle, percutaneous approach (when specified as a lead for a contractility modulation device)

Inpatient Hospital DRG Assignment

DIAGNOSIS RELATED GROUP (DRG)

MS-DRG	Description		2025 National Base Payment5
275	Cardiac defibrillator implant with cardiac catheterization and MCC		$49,290
276	Cardiac defibrillator implants with MCC or Carotid Sinus Neurostimulator		$43,204
277	Cardiac defibrillator implant without MCC		$32,446
HCPCS LEVEL II DEVICE CROSSWALK
Device Category	Device Description	Model Number	HCPCS C-Code6
IPG	OPTIMIZER® Smart	10-B411-3-XX	C1824
IPG	OPTIMIZER® Smart Mini	10-B501-3-XX	C1824
IPG	OPTIMIZER® Lite	10-B502-3-XX	C1824
Patient Charger	OPTIMIZER® Mini Charger System	10-F202-3-XX	K1030 (used for replacements only)
Patient Charger	Guardio Charger System	10-F311-3-XX	K1030 (used for replacements only)
Patient Charger	Vesta Charger System	10-F301-3-XX	K1030 (used for replacements only)

• Patient Charger Vesta Charger System  (OPT Lite) 10-F302-3-XX K1030 (used for replacements only)
• Lead Therapy Delivery Lead Various C1898
• Introducer Introducer/Sheath Various Various

DESCRIPTIONS

HCPCS LEVEL II CODES & DESCRIPTIONS

HCPCS Code	Device Description	Revenue Code
C1824	Generator, cardiac contractility modulation (implantable)	0278 – Other implants
C1898	Lead, pacemaker, other than transvenous VDD single pass	0275 – Pacemakers

K1030   External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only

Disclaimer
Coding, coverage and reimbursement related information provided by Impulse Dynamics is obtained from third party sources. This information is provided for the convenience of the health care provider only and does not constitute reimbursement, legal or compliance advice. Coding, coverage and reimbursement information is subject to frequent and unexpected change; therefore Impulse Dynamics recommends that users refer to the information sources listed to verify accuracy prior to acting on the information provided herein. Impulse Dynamics makes no representation or warranty regarding this information or its accuracy, completeness or applicability and assumes no responsibility for updating this information. Impulse Dynamics specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Impulse Dynamics does not guarantee that use or reliance upon any of the codes listed in this document will result in any specified or guaranteed coverage level or reimbursement amount. Impulse Dynamics strongly encourages health care providers to submit accurate and appropriate claims for services and recommends that you consult directly with payers (e.g. the Centers for Medicare and Medicaid Services (CMS)), certified reimbursement coding professionals, other reimbursement experts, and/or legal counsel regarding all coding, coverage, and reimbursement issues.

Indications for use

• CCM therapy is indicated to improve 6-minute hall walk distance, quality of life and functional status of NYHA Class III heart failure patients who remain symptomatic despite guideline directed medical therapy, are not receiving CRT, and have an LVEF ranging from 25% to 45%.
• Optimizer® devices deliver non-excitatory CCM signals to the heart and have no pacemaker or ICD functions.

Contraindications:
Use of CCM is contraindicated in:

1. Patients with a mechanical tricuspid valve
2. Patients in whom vascular access for implantation of the leads cannot be obtained

References:

1. Current Procedural Terminology (CPT®) Professional Edition 2020. Copyright 1995-2020 American Medical Association. All rights reserved.
2. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc
3. ICD-10-CM Expert for Physicians and Hospitals, 2020. AAPC.
4. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-pcs
5. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page
6. 2020 Alpha-Numeric HCPCS File.

Impulse Dynamics

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• 401 Route 73 N, Building 50, Suite 100 Marlton, NJ 08053-3449
• 856-642-9933
• © 2025 Impulse Dynamics
• www.impulse-dynamics.com
• reimbursement@impulse-dynamics.com

Documents / Resources

IMPULSE DYNAMICS Implantable Optimizer Smart System [pdf] User Guide 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, Implantable Optimizer Smart System, Optimizer Smart System, Smart System, System

References

• User Manual