IMPULSE DYNAMICS 0408T Cardiac Contractility Modulations Implants User Guide

2024 CODING & REIMBURSEMENT GUIDE

0408T Cardiac Contractility Modulations Implants

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.

CPT
Code 1 Description
OPPS
APC
OPPS 2024 Medicare
Status National
Indicator Average Payment 2
CCM® INSERTION OR REPLACEMENT PROCEDURES

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| 5232| J1| $31,379
---|---|---|---|---
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| 5232| J1| $31,379
0410T| Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only| 5222| J1| $8,103
0411T| Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular electrode only| 5222| J1| $8,103

CCM® REMOVAL PROCEDURES

0412T| Removal of permanent cardiac contractility modulation system; pulse generator only| 5221| Q2(T)| $3,746
---|---|---|---|---
0413T| Removal of permanent cardiac contractility modulation system;
transvenous electrode (atrial or ventricular)| 5221| Q2(T)| $3,746
0414T| Removal and replacement of permanent cardiac contractility modulation system pulse generator only| 5231| J1| $2,482

CCM® REPOSITIONING PROCEDURES

0415T| Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular lead)| 5181| T| $599
---|---|---|---|---
0416T| Relocation of skin pocket for implanted cardiac contractility modulation pulse generator| 5054| T| $1,739

CCM® PROGRAMMING PROCEDURES

0417T| 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, including review and report, implantable cardiac contractility modulation system| 5741| Q1(S)| $36
---|---|---|---|---
0418T| Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable cardiac contractility modulation system| 5741| Q1(S)| $36

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  our 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.

INSERTION/REPLACEMENT PROCEDURES

33207| Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular| 14.09| 7.8
---|---|---|---
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| 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

9.9
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 right
ventricular) 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| 6.3

PROGRAMMING/EVALUATION PROCEDURES

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| 2.35| 0.77
---|---|---|---
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 pacemaker system| 1.23| 0.43
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| 1.36| 0.75
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| 2.91| 1.15

**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

(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| 2024 National Base Payment
5
---|---|---
275| Cardiac defibrillator implant with cardiac catheterization and MCC| $49,262
276| Cardiac defibrillator implant with MCC| $43,481
277| Cardiac defibrillator implant without MCC| $33,484

HCPCS LEVEL II DEVICE CROSSWALK

Device Category| Device Description| Model Number| HCPCS C-Code
6
---|---|---|---
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

HCPCS LEVEL II CODES & DESCRIPTIONS

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 indicated for 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
50 Lake Center Executive Park
401 Route 73 N, Building 50, Suite 100
Marlton, NJ 08053-3449
856-642-9933
www.impulse-dynamics.com
reimbursement@impulse-dynamics.com
© 2024 Impulse Dynamics
ID-RB001-US Rev 16

References

• Business Applications | Microsoft Dynamics 365
• CCM Therapy for Heart Failure | Impulse Dynamics
• Reimbursement Resources | The Optimizer® Smart by Impulse Dynamics
• 2024 ICD-10-PCS | CMS
• FY 2024 IPPS Final Rule Home Page | CMS
• CMS-1786-FC | CMS

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