Abbott Ambulatory Surgical Center ASC and Office Based Lab OBL Reimbursement Guide User Manual

HEALTH ECONOMICS & REIMBURSEMENT
AMBULATORY SURGICAL
CENTER (ASC) & OFFICE
BASED LAB (OBL)
REIMBURSEMENT GUIDE
Effective Dates: January 1, 2024 to December 31, 2024

VASCULAR

PHYSICIAN REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES

2024
FACILITY| 2024
NON-FACILITY
ILIAC ARTERY REVASCULARIZATION
37220| Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty| $381| $2,411
37221| Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed| $469| $2,960
+37222| Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)| $176| $595
+37223| Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| $202| $1,221
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION
37224| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty| $424| $2,803
37225| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed| $570| $8,404
37226| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed| $494| $7,785
37227| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed| $682| $10,732
TIBIAL/PERONEAL ARTERY REVASCULARIZATION
37228| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty| $515| $3,972
37229| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed| $660| $8,551
37230| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty  within  the  same  vessel, when performed| $660| $8,565
37231| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed| $699| $11,308
+37232| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)| $190| $790
+37233| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| $306| $1,015
+37234| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| $268| $3,492
---|---|---|---
+37235| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| $350| $3,794
TRANSLUMINAL BALLOON ANGIOPLASTY
37246| Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery| $332| $1,746
+37247| Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)| $165| $568
37248| Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein| $283| $1,302
+37249| Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)| $139| $426
ARTERIAL MECHANICAL THROMBECTOMY
37184| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharma- cological thrombolytic injection(s); initial vessel| $411| $1,645
+37185| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)| $155| $457
+37186| Secondary percutaneous transluminal thrombectomy (eg,  nonprimary mechanical,  snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechani- cal thrombectomy (List separately in addition to code for primary procedure)| $232| $1,140
VENOUS MECHANICAL THROMBECTOMY
37187| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural phar- macological thrombolytic injections and fluoroscopic guidance| $375| $1,626
37188| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy| $268| $1,393
---|---|---|---
THROMBOLYSIS
37211| Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day| $369| NA
37212| Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day| $322| NA
37213| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subse- quent day during course of thrombolytic therapy, including follow-up catheter contrast injec- tion, position change, or exchange, when performed| $220| NA
37214| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method| $116| NA
EMBOLIZATION/CATHETER ACCESS
37241| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)| $407| $4,441
37242| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)| $453| $6,788

37243

| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction| $532| $8,226
37244| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation| $628| $6,284
36140| Introduction of needle or intracatheter, upper or lower extremity artery| $85| $494
36160| Introduction of needle or intracatheter, aortic, translumbar| $118| $533
36200| Introduction of catheter, aorta| $133| $572
36245| Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family| $225| $1,195
36246| Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family| $242| $805
36247| Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family| $284| $1,367

PHYSICIAN REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES

2024
FACILITY| 2024
NON-FACILITY
EMBOLIZATION/CATHETER ACCESS (CONT’D)
+36248| Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)| $46| $112
DIAGNOSTIC ANGIOGRAPHY LOWER EXTREMITY
75710| Angiography, extremity, unilateral, radiological supervision and interpretation| $80| $147
75716| Angiography, extremity, bilateral, radiological supervision and interpretation| $89| $160
DIALYSIS CIRCUIT
36901| Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report| $160| $681
36902| … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty| $229| $1,163
36903| … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment| $301| $4,076
36904| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s);| $351| $1,740
36905| … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty| $421| $2,189
36906| … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment| $486| $5,188
+36907| Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)| $139| $567
+36908| Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)| $197| $1,360
+36909| Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)| $192| $1,818
+34713| Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure)| $118| NA

CPT‡ Code 34713 is applicable only for aortic and iliac artery repair procedures using an endograft. The code may be listed twice for bilateral procedures. This will result in a total payment of 150% of the base payment rate (National Average Payment = $177.00).

It is incumbent upon the physician to determine which, if any modifiers should be used first.
NA: There is no established Medicare payment in this setting.
(+) = Indicates add-on code. List add-on code separately in addition to code for primary procedure.

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
PCI PROCEDURES
92920| Percutaneous transluminal coronary angioplasty; single major coronary artery or branch| $506| NA
+92921| Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)| No separate payment| No separate payment
92928| Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch| $563| NA
+92929| Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)| No separate payment| No separate payment
C9600| Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch| See 92928 for payment| NA
+C9601| Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)| No separate payment| No separate payment
93454| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;| $228| $875
93455| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography| $266| $976
93456| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization| $297| $1,089
93457| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization| $333| $1,187
93458| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when per- formed| $281| $1,007
93459| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| $319| $1,083
93460| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed| $356| $1,202
93461| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| $394| $1,326
CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
**ANGIOGRAPHY WITH OCT IMAGING AND PHYSIOLOGY ASSESSMENT***
C7516| Coronary angiography with IVUS or OCT| NA| NA
C7521| Right heart catheterization with IVUS or OCT| NA| NA
C7522| Right heart catheterization with “flow reserve”| NA| NA
C7523| Left heart catheterization with IVUS or OCT| NA| NA
C7524| Left heart catheterization with “flow reserve”| NA| NA
C7525| Coronary angiography in graft with left heart catheterization with IVUS or OCT| NA| NA
C7526| Coronary angiography in graft with left heart catheterization with “flow reserve”| NA| NA
C7527| Coronary angiography with right and left heart catheterization with IVUS or OCT| NA| NA
C7528| Coronary angiography with right and left heart catheterization with “flow reserve”| NA| NA
C7529| Coronary angiography in graft with right and left heart catheterization with “flow reserve”| NA| NA

• These codes only apply to the ASC site of service and do not impact physician reimbursement.

ASC REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES

CPT ‡ CODE| CPT ‡ **CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
ILIAC ARTERY REVASCULARIZATION
37220| Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with trans- luminal angioplasty| $3,275
37221| Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed| $6,772
+37222| Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac ves- sel; with transluminal angioplasty (List separately in addition to code for primary procedure)| No separate payment
+37223| Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| No separate payment
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION
37224| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty| $3,452
37225| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed| $11,695
37226| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed| $7,029
37227| Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed| $11,873
TIB IAL/PERONEAL ARTERY REVASCULARIZATION**
37228| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty| $6,333
37229| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed| $11,096
37230| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed| $10,735
37231| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed| $11,981
+37232| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)| No separate payment

+37233

| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| No separate payment
TIBIAL/PERONEAL ARTERY REVASCULARIZATION (CONT’D)

+37234| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| No separate payment
+37235| Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)| No separate payment
TRANSLUMINAL BALLOON ANGIOPLASTY
37246| Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery| $3,280
+37247| Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)| No separate payment
37248| Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein| $2,526
+37249| Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)| No separate payment
ARTERIAL MECHANICAL THROMBECTOMY
37184| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel| $10,116
+37185| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)| No separate payment
+37186| Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)| No separate payment
VENOUS MECHANICAL THROMBECTOMY
37187| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance| $7,269

(+) = Indicates add-on code. List add-on code separately in addition to code for primary procedure.
No Separte Payment expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private
payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any modifiers should be used first.

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
VENOUS MECHANICAL THROMBECTOMY (CONT’D)
37188| Percutaneous transluminal mechanical thrombectomy,  vein(s),  including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy| $2,568
THROMBOLYSIS
37211| Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day| $3,658
37212| Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day| $1,964
37213| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed| NA
37214| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method| NA
EMBOLIZATION/CATHETER ACCESS
37241| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intra- procedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)| $6,108
37242| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)| $11,286
37243| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intrapro- cedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction| $4,848
37244| Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intra- procedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation| NA
36140| Introduction of needle or intracatheter, upper or lower extremity artery| No separate payment
36160| Introduction of needle or intracatheter, aortic, translumbar| No separate payment
36200| Introduction of catheter, aorta| No separate payment
36245| Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family| No separate payment
36246| Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family| No separate payment
36247| Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family| No separate payment
+36248| Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)| No separate payment
---|---|---
DIAGNOSTIC ANGIOGRAPHY
75710| Angiography, extremity, unilateral, radiological supervision and interpretation| NA
75716| Angiography, extremity, bilateral, radiological supervision and interpretation| NA
DIALYSIS CIRCUIT
36901| Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report| $554
36902| … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty| $2,526
36903| … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imag- ing and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment| $6,931
36904| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s);| $3,223
36905| … with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radio- logical supervision and interpretation necessary to perform the angioplasty| $6,106
36906| … with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment| $11,288
+36907| Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, includ- ing all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)| No separate payment
+36908| Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)| No separate payment
+36909| Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)| No separate payment
+34713| Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure)| No separate payment

ASC REIMBURSEMENT FOR CORONARY PROCEDURES

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
PCI PROCEDURES
92920| Percutaneous transluminal coronary angioplasty; single major coronary artery or branch| $3,413
+92921| Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)| No separate payment
92928| Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch| $6,616
+92929| Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)| No separate payment
C9600| Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch| $6,706
+C9601| Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)| No separate payment
93454| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;| $1,633
93455| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography| $1,633
93456| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization| $1,633
93457| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization| $1,633
93458| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed| $1,633
93459| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| $1,633
93460| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed| $1,633
93461| Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography| $1,633
ANGIOGRAPHY WITH OCT IMAGING AND PHYSIOLOGY ASSESSMENT

C7516| Coronary angiography with IVUS or OCT| $2,526
C7521| Right heart catheterization with IVUS or OCT| $2,526
C7522| Right heart catheterization with “flow reserve”| $2,526
C7523| Left heart catheterization with IVUS or OCT| $2,526
C7524| Left heart catheterization with “flow reserve”| $2,526
C7525| Coronary angiography in graft with left heart catheterization with IVUS or OCT| $2,526
C7526| Coronary angiography in graft with left heart catheterization with “flow reserve”| $2,526
C7527| Coronary angiography with right and left heart catheterization with IVUS or OCT| $2,526
C7528| Coronary angiography with right and left heart catheterization with “flow reserve”| $2,526
C7529| Coronary angiography in graft with right and left heart catheterization with “flow reserve”| $2,526

CARDIAC RHYTHM MANAGEMENT

PHYSICIAN REIMBURSEMENT FOR PACEMAKERS

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
SYSTEM IMPLANT OR REPLACEMENT
33206| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial| $439| NA
33207| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular| $461| NA
33208| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular| $499| NA
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)
33227| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system| $328| NA
33228| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system| $343| NA
SYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER
33214| Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)| $463| NA
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)
33233| Removal of permanent pacemaker pulse generator only| $227| NA
GENERATOR IMPLANT
33212| Insertion of pacemaker pulse generator only; with existing single lead| $313| NA
33213| Insertion of pacemaker pulse generator only; with existing dual leads| $327| NA
RELOCATION OF SKIN POCKET
33222| Relocation of skin pocket for pacemaker| $333| NA
LEAD PROCEDURES
33216| Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator| $359| NA
33217| Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator| $357| NA
33215| Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode| $300| NA
33218| Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator| $377| NA
33220| Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator| $369| NA
33234| Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular| $467| NA
33235| Removal of transvenous pacemaker electrode(s); dual lead system| $614| NA

PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
PACEMAKER/CRT-P DEVICE MONITORING – IN PERSON
93279| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber| $30| $66
93280| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system| $35| $77
93281| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system| $40| $82
93288| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system| $20| $55
93286| Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system| $14| $44
93293| Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days| $14| $43
PACEMAKER/CRT-P DEVICE MONITORING – REMOTE
93294| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional| $28| $28
93296| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| NA| $21
ICD/CRT-D DEVICE MONITORING – IN PERSON
93282| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system| $39| $78
93283| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system| $53| $95
93284| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system| $58*| $103

93296: The physician practice may only bill the technical service if the physician personally performs the technical service or employs the staff member who performs the technical service. If a device industry representative is involved in performing the technical service under the physician’s direction, then the physician may only bill the professional service, i.e., physician analysis, review(s) and reports(s).
The National Facility rates shown with an reflect payment when modifier 26 is used (i.e. payment only for the professional component).

PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
ICD/CRT-D DEVICE MONITORING – IN PERSON continued
93289| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements| $35| $70
93287| Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system| $21| $51
ICD/CRT-D DEVICE MONITORING – REMOTE
93295| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional| $35| $35
93296| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| NA| $21
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – IN PERSON
93290| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors| $20| $52
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – REMOTE
93297| Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional| NA| $59
G2066| Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac  rhythm monitor  system,  remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| Carrier priced| Carrier priced
ICM DEVICE MONITORING – IN PERSON
93285| Programming device evaluation, (in person) with iterative adjustment of the implantable device to test function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm monitor system| $24| $59
93291| Interrogation device evaluation, (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; including heart rhythm derived data analysis, subcutaneous cardiac rhythm monitor system, including heart rhythm derived data| $17*| $48

PHYSICIAN REIMBURSEMENT FOR CARDIAC DEVICE MONITORING

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
93298| Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of heart rhythm derived data, analysis review(s) and report(s) by a physician or other qualified health care professional| NA| $100

PHYSICIAN REIMBURSEMENT FOR IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
IMPLANT| | |
33285| Insertion, subcutaneous cardiac rhythm monitor, including programming| $84| $4,071
**REMOVAL**
33286| Removal, subcutaneous cardiac rhythm monitor| $82| $127

PHYSICIAN REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
SYSTEM IMPLANT OR REPLACEMENT
33249| Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber| $879| NA
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)
33262| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system| $360| NA
33263| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system| $374| NA
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)
33241| Removal of implantable defibrillator pulse generator only| $209| NA
GENERATOR IMPLANT
33240| Insertion of implantable defibrillator pulse generator only; with existing single lead| $356| NA
33230| Insertion of implantable defibrillator pulse generator only; with existing dual leads| $362| NA
RELOCATION OF SKIN POCKET
33223| Relocation of skin pocket for implantable defibrillator| $396| NA
LEAD PROCEDURES
33216| Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator| $359| NA
33217| Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator| $357| NA
33215| Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode| $300| NA
33218| Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator| $377| NA
33220| Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator| $369| NA
33244| Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction| $833| NA

PHYSICIAN REIMBURSEMENT FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT)

CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Add-on codes qualify for separate payment for physicians and are not subject to the Physician Multiple Payment Reduction Rule.

CPT ‡ CODE| ADD-ON CODE CPT ‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE)| MEDICARE RATE| REPORT WITH PRIMARY PROCEDURE CODE
---|---|---|---
2024
FACILITY| 2024
NON-FACILITY
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES
+33225| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure)| $442| NA| 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33221, 33223, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33240, 33249, 33263, or 33264

PHYSICIAN ADDITIONAL CODES

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
OTHER CRT PROCEDURES
33224| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)| $419| NA
33226| Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)| $405| NA
33229| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system| $360| NA
33221| Insertion of pacemaker pulse generator only; with existing multiple leads| $346| NA
33264| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system| $390| NA
33231| Insertion of implantable defibrillator pulse generator only; with existing multiple leads| $388| NA

ASC REIMBURSEMENT FOR PACEMAKERS

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
SYSTEM IMPLANT OR REPLACEMENT
33206| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial| $7,223
33207| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular| $7,421
33208| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular| $7,639
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)
33227| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system| $6,297
33228| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system| $7,465
SYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER
33214| Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)| $7,663
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)
33233| Removal of permanent pacemaker pulse generator only| $5,580
GENERATOR IMPLANT
33212| Insertion of pacemaker pulse generator only; with existing single lead| $6,316
33213| Insertion of pacemaker pulse generator only; with existing dual leads| $7,588
RELOCATION OF SKIN POCKET
33222| Relocation of skin pocket for pacemaker| $946
LEAD PROCEDURES
33216| Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator| $5,643
33217| Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator| $5,430
33215| Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode| $1,548
33218| Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator| $2,037
33220| Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator| $2,662
33234| Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular| $2,690
33235| Removal of transvenous pacemaker electrode(s); dual lead system| $2,037

ASC REIMBURSEMENT FOR CARDIAC DEVICE MONITORING

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
PACEMAKER/CRT-P DEVICE MONITORING – IN PERSON
93279| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber| NA
93280| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system| NA
93281| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system| NA
93288| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encoun- ter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system| NA
93286| Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system| NA
93293| Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days| NA
PACEMAKER/CRT-P DEVICE MONITORING – REMOTE
93294| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional| NA
93296| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| NA
ICD/CRT-D DEVICE MONITORING – IN PERSON
93282| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system| NA
93283| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system| NA
93284| Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system| NA
93289| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements| NA
93287| Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system| NA

ASC REIMBURSEMENT FOR CARDIAC DEVICE MONITORING

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
ICD/CRT-D DEVICE MONITORING – REMOTE
93295| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional| NA
93296| Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| NA
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – IN PERSON
93290| Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors| NA
IMPLANTABLE CARDIOVASCULAR PHYSIOLOGIC MONITORING – REMOTE
93297| Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional| NA
G2066| Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results| NA
ICM DEVICE MONITORING – IN PERSON
93285| Programming device evaluation, (in person) with iterative adjustment of the implantable device to test function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm monitor system| NA
93291| Interrogation device evaluation, (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; including heart rhythm derived data analysis, subcutaneous cardiac rhythm monitor system, including heart rhythm derived data| NA
ICM DEVICE MONITORING – REMOTE
93298| Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of heart rhythm derived data, analysis review(s) and report(s) by a physician or other qualified health care professional| NA

ASC REIMBURSEMENT FOR IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
IMPLANT| |
33285| Insertion, subcutaneous cardiac rhythm monitor, including programming| $6,904
REMOVAL| |
33286| Removal, subcutaneous cardiac rhythm monitor| $365

ASC REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
SYSTEM IMPLANT OR REPLACEMENT
33249| Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber| $24,843
GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)
33262| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system| $19,146
33263| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system| $19,129
GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)
33241| Removal of implantable defibrillator pulse generator only| $2,037
GENERATOR IMPLANT
33240| Insertion of implantable defibrillator pulse generator only; with existing single lead| $19,843
33230| Insertion of implantable defibrillator pulse generator only; with existing dual leads| $19,039
RELOCATION OF SKIN POCKET
33223| Relocation of skin pocket for implantable defibrillator| $946
LEAD PROCEDURES
33216| Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator| $5,643
33217| Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator| $5,430
33215| Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode| $1,548
33218| Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator| $2,037
33220| Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator| $2,662

ASC REIMBURSEMENT FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT)

CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Medicare does not make separate payment for add-on code 33225 in the ASC setting.

CPT ‡ CODE| ADD-ON CODE CPT ‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE)| REPORT WITH PRIMARY PROCEDURE CODE| MEDICARE RATE ASC
---|---|---|---
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES
Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) ”
(List separately in addition to code for primary procedure)
+33225| 33206| $7,223
33207| $7,421
33208| $7,639
33212| $6,316
33213| $7,588
33214| $7,663
33216| $5,643
33217| $5,430
33221| $13,052
33223| $946
33228| $7,466
33229| $12,867
33230| $19,039
33231| $25,183
33233| $5,580
33234| $2,690
33235| $2,037
33240| $19,843
33249| $24,843
33263| $19,129
33264| $25,027

ASC ADDITIONAL CODES

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
OTHER CRT PROCEDURES
33224| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)| $7,724
33226| Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)| $1,950
33229| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system| $12,867
33221| Insertion of pacemaker pulse generator only; with existing multiple leads| $13,052
33264| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system| $25,027
33231| Insertion of implantable defibrillator pulse generator only; with existing multiple leads| $25,183

+ Indicates an add-on-code. List add-on-code(s) separately in addition to the primary procedure performed.

NEUROMODULATION

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
TRIAL PROCEDURE
63650| Percutaneous implantation of neurostimulator electrode array, epidural| $407| $2,236
PERMANENT PROCEDURES
63650| Percutaneous implantation of neurostimulator electrode array, epidural| $407| $2,236
63655| Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural| $838| NA
63685| Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver| $337| NA
REVISION AND REMOVAL PROCEDURES
63661| Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy when performed| $326| $675
63662| Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed| $851| NA
63663| Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed| $444| $889
63664| Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) via laminotomy or laminectomy, including fluoroscopy, when performed| $886| NA
63688| Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array| $298| NA
ELECTRONIC ANALYSIS AND DEVICE PROGRAMMING
95970| Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming| $18| $18
95971| Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional| $38| $47
95972*| Electronic analysis of implanted neurostimulator pulse generator/transmitter (e.g., contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (e.g., sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional| $39| $56

• A physician or an auxiliary person employed by and under the direct supervision of that physician may provide, with or without the support of the manufacturer’s representative, analysis and programming of a patient’s medical product or device “incident to” the physician’s other services performed in the office setting. A patient or his payer should not be billed for analysis and programming services performed at the direction of the physician by a manufacturer’s representative. Contact your MAC or other payer for any questions regarding coverage, coding and payment.
  NA: There is no Medicare valuations for these codes and these procedures are not typically performed in an in-office setting.

PHYSICIAN REIMBURSEMENT FOR RADIOFREQUENCY ABLATION (RFA)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
CERVICAL SPINE/THORACIC SPINE
64633| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint| $188| $430
64634| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint| $65| $251
LUMBAR SPINE/SACRAL SPINE
64635| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint| $188| $434
64636| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint| $57| $236
GENICULAR NERVE
64624| Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed| $143| $382
SACROILIAC JOINT
64625| Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography)| $191| $465
OTHER PERIPHERAL NERVES
*64640| Destruction by neurolytic agent; other peripheral nerve or branch| $117| $244
77002| Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)| NA| $114
UNLISTED PROCEDURE
64999| Unlisted procedure, nervous system| NA| Carrier priced

PHYSICIAN REIMBURSEMENT FOR DEEP BRAIN STIMULATION (DBS)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
DIAGNOSTIC SERVICES
70450-26| Computed tomography, head or brain; without contrast material| $39| $39
70551-26| Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material| $68| $68
76376-26| 3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image post processing under concurrent supervision; not requiring image post processing on an independent workstation| $9| $9
76377-26| 3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image post processing under concurrent supervision; requiring image post processing on an independent workstation| $37| $37
LEAD PROCEDURES
61863| Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array| $1,506| NA
61864| Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)| $278| NA
61867| Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array| $2,272| NA
61868| Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; each additional array (List separately in addition to primary procedure)| $491| NA
61880| Revision or removal of intracranial neurostimulator electrodes| $591| NA
INTRAOPERATIVE STIMULATION WITH MICROELECTRODE RECORDING
95961-26| Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician or other qualified health care professional| $156| $156
95962-26| Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician or other qualified health care professional (List separately in addition to code for primary procedure)| $166| $166

NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. Modifier 26 signifies the professional component of the hospital-based services

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE
---|---|---
2024
FACILITY| 2024
NON-FACILITY
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES
61885| Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array| $530| NA
61886| Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays| $885| NA
61888| Revision or removal of cranial neurostimulator pulse generator or receiver| $398| NA
**IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING**
95970| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming| $18| $18
95983*| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/ transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional| $48| $49
95984| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/ transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)| $42| $43

ASC REIMBURSEMENT FOR SPINAL CORD STIMULATION (SCS)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
TRIAL PROCEDURE
63650| Percutaneous implantation of neurostimulator electrode array, epidural| $4,952
PERMANENT PROCEDURES
63650| Percutaneous implantation of neurostimulator electrode array, epidural| $4,952
63655| Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural| $17,993
63685| Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver| $25,298
REVISION AND REMOVAL PROCEDURES
63661| Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy when performed| $898
63662| Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed| $1,898
63663| Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed| $4,864
63664| Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) via laminotomy or laminectomy, including fluoroscopy, when performed| $10,317
63688| Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array| $1,898
ELECTRONIC ANALYSIS AND DEVICE PROGRAMMING
95970| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming| NA
95971| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming| NA
95972*| Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional| NA

”NA” expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any, modifiers should be used first.

ASC REIMBURSEMENT FOR RADIOFREQUENCY ABLATION (RFA)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
CERVICAL SPINE/THORACIC SPINE
64633| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint| $898
64634| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint| NA
LUMBAR SPINE/SACRAL SPINE
64635| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint| $898
64636| Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint| NA
GENICULAR NERVE
64624| Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed| $898
SACROILIAC JOINT
64625| Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)| $898
OTHER PERIPHERAL NERVES
*64640| Destruction by neurolytic agent; other peripheral nerve or branch| $173
77002| Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)| NA
UNLISTED PROCEDURE
64999| Unlisted procedure, nervous system| NA

ASC REIMBURSEMENT FOR DEEP BRAIN STIMULATION (DBS)

CPT ‡ CODE| CPT ‡ CODE DESCRIPTION| MEDICARE RATE ASC
---|---|---
IMPLANTABLE PULSE GENERATOR (IPG) PROCEDURES
61885| Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array| $19,380
61886| Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays| $25,340
61888| Revision or removal of cranial neurostimulator pulse generator or receiver| $10,782
**IMPLANTABLE PULSE GENERATOR (IPG) ANALYSIS AND PROGRAMMING***
61880| Revision or removal of intracranial neurostimulator electrodes| $1,898

*CPT‡ code 64640 may not be billed more than 5 times on a single date of service.
”NA” expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information.
It is incumbent upon the physician to determine which, if any modifiers should be used first.

SUMMARY

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 or authorized for marketing use.
The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. It is the responsibility of the hospital or physician to determine appropriate coding for a particular patient and/ or procedure. Any claim should be coded appropriately and supported with adequate documentation in the medical record. A determination of medical necessity is a prerequisite that Abbott assumes will have been made prior to assigning codes or requesting payments. Any codes provided are examples of codes that specify some procedures, or which are otherwise supported by prevailing coding practices. They are not necessarily correct coding for any specific procedure using Abbott’s products.
Hospitals and physicians should consult with appropriate payers, including Medicare Administrative Contractors, for specific information on proper coding, billing, and payment levels for healthcare procedures. Abbott makes no express or implied warranty or guarantee that (i) the list of codes and narratives in this document is complete or error-free, (ii) the use of this information will prevent difference of opinions or disputes with payers, (iii) these codes will be covered [or (iv) the provider will receive the reimbursement amounts set forth herein]. Reimbursement policies can vary considerably from one region to another and may change over time.
The FDA-approved/cleared labeling for all products may not be consistent with all uses described herein. This document is in no way intended to promote the off-label use of medical devices. The content is not intended to instruct hospitals and/or physicians on how to use medical devices or bill for healthcare procedures.

1. Physician Prospective Payment-Final rule with Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY2024. CMS-1784-F: https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfsfederal-regulation-notices/cms-1784-f
2. Ambulatory Surgical Center Payment-Notice of Final Rulemaking with Comment Period(NFRM) CY2024. CMS-1786cms-FC: https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1786-fc

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EFFECTIVE DATES: JANUARY 1, 2024 – DECEMBER 31, 2024
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References

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