RADIOFREQUENCY Coding and Reimbursement Information 2019

Hospital Outpatient, Ambulatory Surgery Center and Physician Office (Calendar Year Jan 1, 2019 – Dec 31, 2019) MEDICARE NATIONAL BASE PAYMENT CPT Copyright 2019 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Physician Services Fee 3 Hospital Ambulatory Performed in Status 1 2 Performed CPT Description APC Outpatient Surgery Center Hospital or Indicator in Office ASC Ablation Ablation, therapy for reduction or eradication of 1 or more bone tumors (eg, ) includ- 20982 ing adjacent soft tissue when involved by tumor 5114 J1 $5,699.59 $2,744.32 $3,969.35 $381.29 † extension, percutaneous, including imaging guidance when performed; radiofrequency Imaging Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization 77002 N Packaged Packaged Packaged Packaged device) (List separately in addition to code for primary procedure) APC=Ambulatory Payment Classification. Status Indicator J1 is a comprehensive APC. All associated services are packaged within the primary code with J1 status indicator. Status Indicator N payment is packaged into payment for other services. There is no separate APC payment. Physician payment is not impacted by APC payment or status indicators. † Physician Payment incl. in office procedure payment NOTE: Do not report 20982 with 76940, 77002, 77013, 77022.

1. CY 2019 Medicare Hospital Outpatient Prospective Payment System Final Rule; Correction Notice (Federal Register, Vol. 83, No. 248, CMS-1695-CN2 pg 67083-67094 12/28/2018), OPPS Addendum B, effective January 1, 2019. 2. CY 2019 Medicare Ambulatory Surgical Center Payment System Final Rule; Correction Notice (Federal Register, Vol. 83, No. 248, CMS-1695-CN2 pg 67083-67094 12/28/2018), ASC Addendum AA, effective January 1, 2019. 3. CY 2019 Medicare Physician Fee Schedule Final Rule; (Federal Register Vol 83, No. 226, CMS-1693-F, CMS-1693-IFC, CMS-5522-F3, and CMS-1701-F pg 59452-60303, 11/23/18), PFS Addendum B, effective January 1, 2019. 4. HCPCS Level II code C1886 may be used to report the ablation used, however, the Medicare payment for the device is packaged into the APC and ASC payments effective January 1, 2014. Device C-Code4 C1886 Catheter, extravascular tissue ablation, any modality (insertable)

Hospital Inpatient (Fiscal Year Oct 1, 2018 – Sept 30, 2019) ICD-10-PCS MS-DRG Description Estimated Base Payment 6 Procedure Code5 description

Destruction of MS-DRG 495 Thoracic Vertebra, Local Excision and Removal Internal Fixation Devices Except Hip and $26,608.36 0P543ZZ Percutaneous Femur with MCC Approach MS-DRG 496 Local Excision and Removal Internal Fixation Devices Except Hip and $15,069.85 Destruction of Femur with CC Lumbar Vertebra, 0Q503ZZ MS-DRG 497 Percutaneous Local Excision and Removal Internal Fixation Devices Except Hip and $11,028.22 Approach Femur without CC/MCC Copyright 2019 American Medical Association. Documentation must justify MS-DRG used

5. CMS 2019 ICD-10-PCS. ICD-10 codes and descriptions are copyright 2019 World Health Organization; revised for use in the United States by the Centers for Medicare and Medic aid Services (CMS) and the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) as ICD-10-CM / ICD-10-PCS. 6. Fiscal Year (FY) 2019 Medicare Hospital Inpatient Final Rule And Correction Notice Tables 1A-5. Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations MS-DRG payment updating for operating and capital payments, provision for labor and quality data submission less IME and DSH for a teaching hospital. Specific MS-DRG payment varies significantly across hospitals.

CONTINUED Merit.com Coding and Reimbursement Information 2019

Place of Service Code Set7 Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes.

Place of Service Code(s) Place of Service Name Place of Service Description Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility 11 Office (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both sur- 21 Inpatient Hospital gical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions. A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical On Campus-Outpatient 22 and nonsurgical), and rehabilitation services to sick or injured persons who do not require Hospital hospitalization or institutionalization. (Description change effective January 1, 2016) A freestanding facility, other than a physician's office, where surgical and diagnostic services 24 Ambulatory Surgical Center are provided on an ambulatory basis. 7. https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Indications for Use: The STAR™ Tumor Ablation System is indicated for palliative treatment in spinal procedures by ablation of metastatic malignant lesions in a vertebral body. Consult Instructions for Use for additional device information.

Merit Medical Systems, Inc. gathers reimbursement information from third-party sources such as Medicare and presents this information for illustrative purposes only. Merit Medical Systems, Inc. cannot guarantee coverage or payment for products or procedures. Actual payment to providers will vary based on many factors including but not limited to geographic location, setting of care, & hospital facility status (e.g., teaching, non-teaching). Under the MS-DRG system, procedures may be assigned to a number of other MS-DRGs and actual payment to providers may not be limited to the MS-DRGs shown above. Providers should report the codes that most accurately describe the patients’ medical condition, procedures performed, & the products used. Use of the service & the product must comply with Medicare coverage guidelines in being reasonable & necessary for the care of the patient to support reimbursement. Prior to claims submission, it is the provid- ers’ responsibility to confirm appropriate coding for procedures or combination of procedures with specific payers, such as Medicare, and/or coding authorities, such as the American Medical Association and medical societies. Coverage and payment policies also change over time and Merit Medical Systems, Inc. assumes no obligation to update the information provided herein.

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