Ambu aScope 5 Broncho HD Bronchoscopy Suite User Guide

Ambu aScope 5 Broncho HD Bronchoscopy Suite

Product Information

Specifications

• Product Name: aScope 5 Broncho HD
• Features: High-definition (HD) imaging chip, compatibility with high-frequency tools (APC, Cryo, Nd: YAG Laser), superior articulation with tools

Product Usage Instructions

How to Receive Incremental Reimbursement

When using the aScope 5 Broncho HD for procedures, make sure to include the specific CPT code associated with the device to qualify for Transitional Pass- Through (TPT) Payment.

Transitional Pass-Through (TPT) Payment

TPT Payment is intended to facilitate Medicare beneficiary access to new and innovative medical devices that demonstrate substantial clinical improvement over existing technologies.
This allows for incremental reimbursement for outpatient Medicare fee-for- service patients.

Calculating TPT

To calculate TPT payment for a procedure performed with the aScope 5 Broncho HD, follow the example provided in the user manual which involves multiplying the device cost, applying the hospital’s markup rate, adjusting for the cost- to-charge ratio, and adding the APC payment associated with the CPT code.

FAQ

Why is the TPT applicable only for aScope 5 Broncho HD?

The aScope 5 Broncho HD received TPT payment status due to its substantial clinical improvement over existing technologies, as acknowledged by CMS.

What criteria must the technology meet to qualify for TPT?

To qualify for TPT, the technology must be new to the market, demonstrate substantial clinical improvement, and address cost burdens.

How to Receive Incremental Reimbursement When Using aScope 5 Broncho HD

How is TPT Calculated?

Why is this for aScope 5 Broncho HD and Not All Other Scopes?

• Scope 5 Broncho received TPT payment status due to its substantial clinical improvement over existing technologies:
• CMS stated, ”The evidence demonstrates that the device is a substantial clinical improvement over currently available treatment options in the clinical setting.
• 2024 CMS OPPS/ASC Final Rule, 88FR 81738 (Available on CMS website), (November 2023).

WHAT IS TPT?

• Transitional Pass-Through (TPT) Payment is intended to facilitate Medicare beneficiary access to the benefits of new and innovative medical devices, drugs, and biologicals that demonstrate a substantial clinical improvement over existing technologies.

To qualify, the technology must meet the following criteria:

1. Newness to market
2. Substantial clinical improvement
3. Cost burden

This qualifies specific procedures performed with a scope 5 Broncho HD incremental reimbursement for Outpatient Medicare fee-for-service patients to facilities for bronchoscopy procedures

Additional Information

1. Examples of TPT Calculations
2. Device Offsets
3. Why TPT?
4. Links to Important Reference Guides
5. Things to Remember

Example of TPT Calculation

FOR DEMONSTRATION PURPOSES ONLY

How TPT could be calculated for CPT 31624 performed with an aScope 5 Broncho HD

1. Calculate the device charge by multiplying device cost ($500) by the hospital’s normal markup rate (3x); $500 x 3 = $1,500
2. Medicare multiplies device charge by revenue center’s cost-to-charge ratio (0.35); $1,500 x 0.35 = $525
3. The CPT code device offset ($2.91) is subtracted to calculate the TPT payment; $525 – $2.91 = $522.09
4. The APC payment associated with the CPT code ($1,617.14) is added to the TPT payment; 522.09 + $1,617.14 = $2,139.23

Device Offsets

2024 CMS CPT Code Device Offset Amounts (when billed with C1601)

aScope 5 Broncho HD Applicable Device Offsets

CPT Code| Description| Device Offset Amount 1| Percent of Applicable Medicare Procedures 2
---|---|---|---
31624| Dx Bronchoscope/Lavage| $2.91| 36.14%
31628| Bronchoscopy/Lung Bx Each| $36.04| 15.57%
31623| Dx Bronchoscope/Brush| $6.47| 10.94%
31629| Bronchoscopy/Needle Bx Each| $44.96| 10.03%
31622| Dx Bronchoscope/Wash| $8.57| 7.98%
31625| Bronchoscopy W/Biopsy(s)| $14.88| 6.32%
31615| Visualization Of Windpipe| $0.16| 4.13%
31645| Bronchoscope W/Ther Aspir 1st| $12.61| 2.19%
31630| Bronchoscopy Dilate/Fx Repr| $421.03| 2.04%
31641| Bronchoscopy Treat Blockage| $251.90| 1.56%
31626| Bronchoscopy W/Markers| $652.77| 1.16%
31635| Bronchoscopy W/Fb Removal| $14.39| 0.65%
31640| Bronchoscopy W/Tumor Excise| $132.02| 0.35%
31636| Bronchoscopy Bronch Stents| $2,808.68| 0.25%
31631| Bronchoscopy Dilate W/Stent| $1,688.99| 0.22%
31648| Bronchial Valve Remove Init| $87.77| 0.13%
31634| Branch W/Balloon Occlusion| $1,161.42| 0.09%
31638| Branch W/Balloon Occlusion| $907.75| 0.07%
31647| Bronchial Valve Init Insert| $3,704.69| 0.07%
31646| Bronchoscope W/Ther Aspir Sbsq| $0.00| 0.03%
31660| Branch Thermoplsty 1 Lobe| $3,220.16| 0.03%
31643| Diag Bronchoscope/Catheter| $10.51| 0.03%
31785| Remove Windpipe Lesion| $83.14| 0.01%
31661| Branch Thermoplsty 2/> Lobes| $3,055.83| 0.01%

1. Pub 100-04 Medicare Claims Processing, CMS Transmittal 12421 (Available on CMS website), (December 21, 2023).
2. Based on 2022 Medicare volumes for applicable claims.

Why TPT?

1. Transitional Pass-Through (TPT) Payment is intended to facilitate Medicare beneficiary access to the benefits of new and innovative medical devices, drugs, and biologicals that demonstrate a substantial clinical improvement over existing technologies
2. The payments are intended to reimburse hospitals and ambulatory surgery centers (ASCs) for utilizing innovative technology whose cost would otherwise potentially limit adoption
3. TPT allows specific Outpatient Medicare fees for service procedures performed with a scope 5 Broncho HD incremental reimbursement
4. The only requirement is adding HCPCS C1601 to relevant claims
5. It’s important to list C1601 so Medicare can track its usage and potentially increase future procedure payments

Links to Important Documents

• Ambu Press Release
• aScope 5 TPT One-pager
• CMS Final Rule
• Device Offsets
• Landing Page
• Reimbursement Guide

Things to Remember:

• C1601 was awarded only to Ambu scope 5 HD and must be included on the claim to receive TPT payment
• Always remember to use C1601 on a claim when a scope 5 Broncho is used
• TPT payments only apply to Medicare FFS patients; however, Medicaid, Medicare Advantage, and commercial health plans may also recognize the C code and provide separate incremental payment
• All facilities will continue to code and submit charges as they normally would but will need to add C1601 to the claim
• TPT went into effect January 1, 2024, and will remain active for 2-3 years
• C1601 — Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)
• Have Questions? Please Email: US-HEALTHECON@AMBU.COM

Documents / Resources

| Ambu aScope 5 Broncho HD Bronchoscopy Suite [pdf] User Guide
aScope 5 Broncho HD Bronchoscopy Suite, aScope 5, Broncho HD Bronchoscopy Suite, HD Bronchoscopy Suite, Suite
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