2015 Procedural Payment Guide Contents

Introduction Disclaimer (print page 2) Description of Payment Methods (print page 3)

 Procedural Payment Guide: Cardiac Rhythm Management and Electrophysiology Procedures (print page range: 4-17)

 Procedural Payment Guide: Interventional Cardiology Select Coronary Interventions (print page range: 18-29)

 Procedural Payment Guide: Select Peripheral Interventions (print page range: 30-44)

Appendix Appendix A: APC Reference Table (print page range: 45-46) Appendix B: Category Codes (C-Codes) Reference Guide 2015 (print page range: 47-48) Appendix C: ICD-9-CM Code Reference Table (print page range: 49-53)

This document is formatted to print in a landscape orientation on letter (8.5 x 11) or legal (8.5 x 14) paper.

CRV-210407-AB FEB2015 2015 Procedural Payment Guide

This Procedural Payment Guide for cardiology, rhythm and peripheral intervention procedures provides coding and reimbursement information for physicians and healthcare facilities.

The codes included in this guide are intended to represent typical cardiology, rhythm and peripheral intervention procedures where there is: 1) at least one device approved by the U.S. Food and Drug Administration (FDA) for use in the listed procedure; and 2) specific procedural coding guidance provided by a recognized coding or reimbursement authority such as the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS). This guide is in no way intended to promote the off-label use of medical devices.

Please note that while these materials are intended to provide coding information for a range of cardiology, rhythm, and vascular peripheral intervention procedures, the FDA- approved/cleared labeling for all products may not be consistent with all uses described in these materials. Some payers, including some Medicare contractors, may treat a procedure which is not specifically covered by a product’s FDA-approved labeling as a non-covered service.

The Medicare reimbursement amounts shown are currently published national average payments. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, proportion of low-income patients, coverage, and/or payment rules. Please feel free to contact the Boston Scientific reimbursement department at 1-800-CARDIAC if you have any questions about the information in these materials. You can also find reimbursement updates on our website, www.bostonscientific.com/reimbursement.

CPT® Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Disclaimer Please note: this coding information may include codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. Health economics and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is provided for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label. Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options. CPT® Disclaimer CPT® Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Boston Scientific does not promote the use of its products outside their FDA-approved label.

i CRV-210407-AB FEB2015 2015 Procedural Payment Guide

Physician Billing and Payment: Medicare and most other insurers typically reimburse physicians based on fee schedules tied to Current Procedural Terminology1 (CPT®) codes. CPT codes are published by the AMA and used to report medical services and procedures performed by or under the direction of physicians. Physician payment for procedures performed in an outpatient or inpatient hospital or Ambulatory Surgical Center (ASC) setting is described as an in-facility fee payment (listed as In-Hospital in document) while payment for procedures performed in the physician office is described as an in-office payment. In-facility payments reflect modifier -26 as applicable. Rates referenced in these guides do not reflect sequestration, automatic reductions in federal spending that will result in a 2% across-the-board reduction to ALL Medicare rates as of January 1, 2014.

Hospital Outpatient Billing and Payment: Medicare reimburses hospitals for outpatient stays (typically stays of less than 48 hours) under Ambulatory Payment Classification (APC) groups. Medicare assigns an APC to a procedure based on the billed CPT/HCPCS (Healthcare Common Procedural Coding System) code. (Note that private insurers may require ICD- 9 [International Classification of Diseases-Volume 9] procedure codes for outpatient payment.) While it is possible that separate APC payments may be deemed appropriate where more than one procedure is done during the same outpatient visit, many APCs are subject to reduced payment when multiple procedures are performed on the same day. In most cases, the most heavily weighted or highest paying procedure is paid at 100 percent and all other procedures are subject to a 50 percent payment reduction.

Hospitals are required to report device category codes (C-codes) on claims when such devices are used in conjunction with procedure(s) billed and paid for under the OPPS. This reporting provides claims data used annually to update the OPPS payment rates. Although separate payment is not typically available for C-Codes, denials may result if applicable C- Codes are not included with associated procedure codes CMS has an established cost center for “Implantable Devices Charged to Patients”, available for cost reporting periods since May 1, 2009. As CMS uses data from this cost center to establish OPPS payments, it is important for providers to document device costs in this cost center to help ensure appropriate payment amounts.

Hospital Inpatient Billing and Payment: Medicare reimburses hospital inpatient procedures based on the Medicare Severity Diagnosis Related Group (MS-DRG). The MS-DRG is a system of classifying patients based on their diagnoses and the procedures performed during their hospital stay. MS-DRGs closely calibrate payment to the severity of a patient’s illness. One single MS-DRG payment is intended to cover all hospital costs associated with treating an individual during his or her hospital stay, with the exception of “professional” (e.g., physician) charges associated with performing medical procedures. Private payers may also use MS-DRG-based systems or other payer-specific system to pay hospitals for providing inpatient services. Effective October 1, 2013, Medicare implemented two-midnight stay guidance. Inpatient admittance is presumed to be appropriate if a physician expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary to the hospital based on that expectation. Documentation in the medical record must support a reasonable expectation of the need for the beneficiary to require a medically necessary stay lasting at least two midnights. If the inpatient admission lasts fewer than two midnights due to an unforeseen circumstance this also must be clearly documented in the medical record.

ASC Billing and Payment: Many elective procedures are performed outside of the hospital in Medicare certified facilities also known as Ambulatory Surgical Centers (ASCs). Not all procedures that Medicare covers in the hospital setting are eligible for payment in an ASC. Medicare has a list of all services (as defined by CPT/HCPCs codes), generally non-surgical, that it covers when offered in an ASC. ASC allowed procedures can be found at http://www.cms.hhs.gov/ASCPayment/. Payments made to ASCs from private insurers depend on the contract the facility has with the payer.

ii CRV-210407-AB FEB2015 Cardiac Rhythm Management and Electrophysiology Procedures 2015 Procedural Payment Guide

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options. Inpatient information effective through September 30, 2015 | APC and ASC Information effective through December 31, 2015 | Physician fee information effective through March 31, 2015. *National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547 HOSPITAL HOSPITAL + signifies Add-on Code *PHYSICIAN2 ASC3 OUPATIENT4 INPATIENT6 CPT® In-Hospital In-Office Work RVU ASC APC APC Possible Possible Code1 CPT Descriptions (-26) (Global) Total RVU8 Payment3 Category Payment4 ICD-9-CM Codes5 MS-DRG Assignment MS-DRG Payment6

Cardiac Rhythm Management Device Implant Procedures go to APC list go to ICD-9-CM list 33206 Insertion of new or replacement of permanent pacemaker with $478 7.39 $7,853 APC 89 $9,493 37.73 Permanent cardiac pacemaker implant transvenous electrode(s); atrial 37.76 $478 13.38 MS-DRG 244 without CC/MCC $12,643 37.80 37.81 MS-DRG 243 with CC $15,658 37.82 37.85 MS-DRG 242 with MCC $21,844

37.86 33207 Insertion of new or replacement of permanent pacemaker with $510 $510 8.05 37.71

transvenous electrode(s); ventricular 14.25 37.76 37.80 37.81 37.82 37.85 37.86 33208 Insertion of new or replacement of permanent pacemaker with $551 $551 8.77 37.72

transvenous electrode(s); atrial and ventricular 15.42 37.76 37.80 37.83 37.87 33212 Insertion of pacemaker pulse generator only; with existing single lead $345 $345 5.26 $5,650 APC 90 $6,545 37.80 Cardiac pacemaker replacement

37.81 9.64 $11,687 37.82 MS-DRG 259 without MCC 37.85 MS-DRG 258 with MCC $16,197 37.86

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407 -AB FEB2015 Cardiac Rhythm Management and Electrophysiology Procedures 2015 Procedural Payment Guide

*National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547 HOSPITAL HOSPITAL + signifies Add-on Code *PHYSICIAN2 ASC3 OUPATIENT4 INPATIENT6 CPT® In-Hospital In-Office Work RVU ASC APC APC Possible Possible Code1 CPT Descriptions (-26) (Global) Total RVU8 Payment3 Category Payment4 ICD-9-CM Codes5 MS-DRG Assignment MS-DRG Payment6

Cardiac Rhythm Management Device Implant Procedures continued go to APC list go to ICD-9-CM list 33213 Insertion of pacemaker pulse generator only; with existing dual leads $360 5.53 $7,853 APC 89 $9,493 37.80 Cardiac pacemaker replacement

37.83 $360 10.07 MS-DRG 259 without MCC $11,687 37.87 00.53 MS-DRG 258 with MCC $16,197

33221 Insertion of pacemaker pulse generator only; with existing multiple $385 $385 5.80 $12,518 APC 655 $16,407 00.53

leads 10.77 37.80 33214 Upgrade of implanted pacemaker system, conversion of single $505 $505 7.84 $7,851 APC 89 $9,493 37.70 Permanent cardiac pacemaker implant

chamber system to dual chamber system (includes removal of 37.71 14.13 MS-DRG 244 without CC/MCC $12,643 previously placed pulse generator, testing of existing lead, insertion of 37.73 new lead, insertion of new pulse generation) 37.87 MS-DRG 243 with CC $15,658 00.50 MS-DRG 242 with MCC $21,844

33215 Repositioning of previously implanted transvenous pacemaker or $321 $321 4.92 $864 APC 103 $1,576 37.75 Cardiac pacemaker revision except device replacement

implantable defibrillator (right atrial or right ventricular) electrode 8.97 MS-DRG 262 without CC/MCC $8,199 MS-DRG 261 with CC $10,882 MS-DRG 260 with MCC $21,970

33216 Insertion of a single transvenous electrode, permanent pacemaker or $395 $395 5.87 $5,651 APC 90 $6,545 37.70 ICD lead procedures

cardioverter-defibrillator 37.71 11.06 MS-DRG 265 $16,799

37.73 37.95 00.52 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or $388 $388 5.84 37.72

cardioverter-defibrillator 10.85 37.95 33218 Repair of single transvenous electrode, permanent pacemaker or $414 6.07 $1,286 APC 105 $2,347 37.75 Cardiac pacemaker revision except device replacement

pacing cardioverter-defibrillator $414 11.59 MS-DRG 262 without CC/MCC $8,199 MS-DRG 261 with CC $10,882 MS-DRG 260 with MCC $21,970

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Cardiac Rhythm Management Device Implant Procedures continued go to APC list go to ICD-9-CM list 33220 Repair of 2 transvenous electrodes for permanent pacemaker or $1,286 37.75 $415 $415 6.15 APC 105 $2,347 Cardiac pacemaker revision except device replacement pacing cardioverter-defibrillator 11.60 MS-DRG 262 without CC/MCC $8,199 33222 Relocation of skin pocket for pacemaker $360 $360 5.10 $771 APC 328 $1,407 37.79 MS-DRG 261 with CC $10,882 10.07 MS-DRG 260 with MCC $21,970

33223 Relocation of skin pocket for implantable-defibrillator $434 $434 6.55 12.15

33224 Insertion of pacing electrode, cardiac venous system, for left $534 $534 9.04 $7,853 APC 89 $9,943 00.52 ICD lead procedures

ventricular pacing, with attachment to previously placed pacemaker or 14.93 MS-DRG 265 $16,799

implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) + 33225 Insertion of pacing electrode, cardiac venous system, for left $485 $485 8.33 Status N, items and 00.52 Cardiac defibrillator implant with cardiac catheterization with

ventricular pacing, at time of insertion of implantable defibrillator or 13.56 services packaged into acute MI/HF/Shock pacemaker pulse generator (eg, for upgrade to dual chamber system) primary procedure APC MS-DRG 222 with MCC $50,777 (List separately in addition to code for primary procedure) rate. No separate payment MS-DRG 223 without MCC $36,908

Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock MS-DRG 224 with MCC $45,008 MS-DRG 225 without MCC $34,378

Cardiac defibrillator implant without cardiac catheterization MS-DRG 226 with MCC $40,808 MS-DRG 227 without MCC $31,963

Permanent cardiac pacemaker implant MS-DRG 242 with MCC $21,844 MS-DRG 243 with CC $15,658 MS-DRG 244 without CC/MCC $12,643

33226 Repositioning of previously implanted cardiac venous system (left $513 $863 37.75 $513 8.68 APC 103 $1,576 Cardiac pacemaker revision except device replacement ventricular) electrode (including removal, insertion and/or replacement 14.34 MS-DRG 262 without CC/MCC $8,199 of existing generator) MS-DRG 261 with CC $10,882 33233 Removal of permanent pacemaker pulse generator only $251 $5,650 37.89 $251 3.39 APC 90 $6,545 7.02 MS-DRG 260 with MCC $21,970

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Cardiac Rhythm Management Device Implant Procedures continued go to APC list go to ICD-9-CM list 33227 Removal of permanent pacemaker pulse generator with replacement $363 5.5 $5,651 APC 90 $6,545 37.80 Cardiac pacemaker revision except device replacement of pacemaker pulse generator; single lead system 37.85 $363 10.15 MS-DRG 262 without CC/MCC $8,199 37.86 MS-DRG 261 with CC $10,882 33228 Removal of permanent pacemaker pulse generator with replacement $378 $378 5.77 $7,853 APC 89 $9,493 37.80 of pacemaker pulse generator; dual lead system 10.57 37.87 MS-DRG 260 with MCC $21,970

00.53 33229 Removal of permanent pacemaker pulse generator with replacement $397 $397 6.04 $12,518 APC 655 $16,407 37.80 of pacemaker pulse generator; multiple lead system 11.09 00.53

33234 Removal of transvenous pacemaker electrode(s); single lead system, $515 $515 7.91 $1,286 APC 105 $2,347 37.77 atrial or ventricular 14.39

33235 Removal of transvenous pacemaker electrode(s); dual lead system $669 $669 10.15 18.72

33240 Insertion of implantable defibrillator pulse generator only; with existing $390 $390 6.05 $20,292 APC 107 $22,916 37.96 AICD generator procedure single lead 10.92 MS-DRG 245 $27,266

33230 Insertion of implantable defibrillator pulse generator only; with existing $408 $408 6.32 37.96 dual leads 11.41 00.54

33231 Insertion of implantable defibrillator pulse generator only; with existing $430 $430 6.59 $27,212 APC 108 $30,818 multiple leads 12.03

33241 Removal of implantable defibrillator pulse generator only $236 $236 3.29 $1,286 APC 105 $2,347 37.79 Cardiac pacemaker revision except device replacement

6.61 MS-DRG 262 without CC/MCC $8,199 MS-DRG 261 with CC $10,882 MS-DRG 260 with MCC $21,970

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Cardiac Rhythm Management Device Implant Procedures continued go to APC list go to ICD-9-CM list 33262 Removal of implantable defibrillator pulse generator with replacement $398 6.06 $20,292 APC 107 $22,916 37.98 AICD Generator Procedures

of implantable defibrillator pulse generator; single lead system $398 11,12 MS-DRG 245 with MCC $27,266

33263 Removal of implantable defibrillator pulse generator with replacement $414 $414 6.33 37.98

of implantable defibrillator pulse generator; dual lead system 11.58 00.54 33264 Removal of implantable defibrillator pulse generator with replacement $431 $431 6.60 $27,212 APC 108 $30,818 00.54

of implantable defibrillator pulse generator; multiple lead system 12,06 33244 Removal of single or dual chamber implantable defibrillator $900 $900 13.99 Not APC 105 $2,347 37.77 Cardiac pacemaker revision except device replacement electrode(s); by transvenous extraction covered 25.18 MS-DRG 262 without CC/MCC $8,199 for ASC payment MS-DRG 261 with CC $10,882 MS-DRG 260 with MCC $21,970

33249 Insertion or replacement of permanent implantable defibrillator system $960 $960 15.17 $27,212 APC 108 $30,818 37.94 Cardiac defibrillator implant with cardiac catheterization with

with transvenous lead(s), single or dual chamber 26.84 00.51 acute MI/HF/Shock MS-DRG 222 with MCC $50,777 MS-DRG 223 without MCC $36,908

Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock MS-DRG 224 with MCC $45,008 MS-DRG 225 without MCC $34,378

Cardiac defibrillator implant without cardiac catheterization MS-DRG 226 with MCC $40,808 MS-DRG 227 without MCC $31,963

33270 Insertion of replacement of permanent subcutaneous implantable $910 $910 9.10 $27,212 APC 108 $30,818 37.94

defibrillator system, with subcutaneous electrode including 17.06 defibrillation threshold evaluation, induction of arrhythmia evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed. 33271 Insertion of subcutaneous implantable defibrillator electrode. $513 $513 7.50 $5,651 APC 90 $6,545 37.95 ICD lead procedures

14.35 MS-DRG 265 $16,799

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Cardiac Rhythm Management Device Implant Procedures continued go to APC list go to ICD-9-CM list 33272 Removal of subcutaneous implantable defibrillator electrode. $378 $378 5.42 N/A APC 105 $2,347 37.77 Cardiac pacemaker revision except device replacement

10.56 MS-DRG 262 without CC/MCC $8,199 MS-DRG 261 with CC $10,882 MS-DRG 260 with MCC $21,970

33273 Reposition of previously implanted subcutaneous implantable $415 $415 6.50 $1,286 APC 105 $2,347 37.75

defibrillator electrode. 11.62

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Cardiac Rhythm Management Device Evaluation Codes go to APC list go to ICD-9-CM list 93279 Programming device evaluation (in person) with iterative adjustment $33 $50 0.65 Not APC 690 $35 89.45 N/A

of the implantable device to test the function of the device and select 1.40 covered 89.46 optimal permanent programmed values with analysis, review and for ASC 89.47 report by a physician or other qualified health care professional; single payment 89.48 lead pacemaker system 93280 Programming device evaluation (in person) with iterative adjustment $39 $59 0.77

of the implantable device to test the function of the device and select 1.65 optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system 93281 Programming device evaluation (in person) with iterative adjustment $45 $69 0.90

of the implantable device to test the function of the device and select 1.92 optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system 93282 Programming device evaluation (in person) with iterative adjustment $43 $64 0.85 ICD-9-CM procedure code does not impact the MS-DRG

of the implantable device to test the function of the device and select 1.79 optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system 93283 Programming device evaluation (in person) with iterative adjustment $58 $82 1.15 89.45

of the implantable device to test the function of the device and select 2.30 89.46 optimal permanent programmed values with analysis, review and 89.47 report by a physician or other qualified health care professional; dual 89.48 lead transvenous implantable defibrillator system 89.49 93284 Programming device evaluation (in person) with iterative adjustment $63 $90 1.25

of the implantable device to test the function of the device and select 2.53 optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system 93260 Programming device evaluation (in person) with iterative adjustment $45 $68 0.85

of the implantable device to test the function of the device and select 1.26 optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system

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Cardiac Rhythm Management Device Evaluation Codes go to APC list go to ICD-9-CM list 93285 Programming device evaluation (in person) with iterative adjustment $26 $43 0.52 Not APC 690 $35 89.54

of the implantable device to test the function of the device and select 1.19 covered optimal permanent programmed values with analysis, review and for ASC report by a physician or other qualified health care professional; payment implantable loop recorder system 93286 Peri-procedural device evaluation (in person) and programming of $15 $28 0.30 N/A N/A 89.45 N/A

device system parameters before or after a surgery, procedure, or 0.77 89.46 test with analysis, review and report by a physician or other qualified 89.47 health care professional; single, dual, or multiple lead pacemaker 89.48 system 89.49 93287 Peri-procedural device evaluation (in person) and programming of $23 $36 0.45 device system parameters before or after a surgery, procedure, or 1.02 test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system 93288 Interrogation device evaluation (in person) with analysis, review and $21 $38 0.43 APC 690 $35 89.45 ICD-9-CM procedure code does not impact the MS-DRG

report by a physician or other qualified health care professional, 1.06 89.46 includes connection, recording and disconnection per patient 89.47 encounter; single, dual, or multiple lead pacemaker system 89.48 93289 Interrogation device evaluation (in person) with analysis, review and $46 $66 0.92 89.49

report by a physician or other qualified health care professional, 1.84 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

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Cardiac Rhythm Management Device Evaluation Codes go to APC list go to ICD-9-CM list 93261 Interrogation device evaluation (in person) with analysis, review and $39 $62 0.74 Not APC 690 $35 ICD-9-CM procedure code does not impact the MS-DRG

report by a physician or other qualified health care professional, 1.10 covered includes connection, recording and disconnection per patient for ASC encounter; implantable subcutaneous lead defibrillator system payment

93290 Interrogation device evaluation (in person) with analysis, review and $21 $31 0.43 89.59

report by a physician or other qualified health care professional, 0.87 includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors 93291 Interrogation device evaluation (in person) with analysis, review and $21 $36 0.43 APC 450 $29 report by a physician or other qualified health care professional, 1.01 includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis 93292 Interrogation device evaluation (in person) with analysis, review and $21 $32 0.43 APC 690 $35 N/A report by a physician or other qualified health care professional, 0.91 includes connection, recording and disconnection per patient encounter; wearable defibrillator system 93293 Transtelephonic rhythm strip pacemaker evaluation(s) single, dual or $16 $54 0.32

multiple lead pacemaker system, includes recording with and without 1.51 magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days 93294 Interrogation device evaluation(s) (remote), up to 90 days; single, $34 $34 0.65 N/A N/A

dual, or multiple lead pacemaker system with interim analysis, 0.96 review(s) and report(s) by a physician or other qualified health care professional

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Cardiac Rhythm Management Device Evaluation Codes go to APC list go to ICD-9-CM list 93295 Interrogation device evaluation(s) (remote), up to 90 days single, dual, $68 $68 1.29 Not N/A N/A N/A

or multiple lead implantable defibrillator system with interim analysis, 1.91 Covered review(s) and report(s) by a physician or other qualified health care for ASC professional payment

93296 Interrogation device evaluation(s) (remote), up to 90 days single, dual, $26 $26 0.00 APC 690 $35

or multiple lead pacemaker system or implantable defibrillator system, 0.73 remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results 93297 Interrogation device evaluation(s), (remote) up to 30 days; $27 $27 0.52 N/A N/A N/A

implantable cardiovascular monitor system, including analysis of 1 or 0.75 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 93298 Interrogation device evaluation(s), (remote) up to 30 days; $27 $27 0.52 implantable loop recorder system, including analysis of recorded heart 0.75 rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional 93299 Interrogation device evaluation(s), (remote) up to 30 days; $0 Contractor 0.00 APC 690 $35

implantable cardiovascular monitor system or implantable loop priced 0.00 recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

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Intracardiac Electrophysiology Procedures/Studies go to APC list go to ICD-9-CM list + 93462 Left heart catheterization by transseptal puncture through intact $280 N/A 3.73 Not Status N, items and 37.22 Percutaneous cardiovascular procedure without coronary

septum or by transapical puncture (List separately in addition to code 6.03 covered services packaged into artery stent for primary procedure) for ASC primary procedure APC MS-DRG 251 without MCC $11,965 payment rate. No separate payment MS-DRG 250 with MCC $17,529

93600 Bundle of His recording $122 2.12 APC 85 $4,635 37.29 ICD-9-CM procedure code does not impact the MS-DRG 3.48 93602 Intra-atrial recording $121 2.12 3.41 93603 Right ventricular recording $122 2.12 APC 84 $873 3.41 + 93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with $292 4.49 Status N, items and 37.26 Percutaneous cardiovascular procedure without coronary

catheter manipulation to record from multiple sites to identify origin of 8.16 services packaged into 37.27 artery stent tachycardia (list separately in addition to code for primary procedure) primary procedure APC MS-DRG 251 without MCC $11,965 rate. No separate payment N/A MS-DRG 250 with MCC $17,529

93610 Intra-atrial pacing $173 3.02 APC 85 $4,635 37.29 ICD-9-CM procedure code does not impact the MS-DRG

4.80 93612 Intraventricular pacing $172 3.02

4.80 + 93613 Intracardiac electrophysiologic 3-dimensional mapping (List $403 6.99 N/A 37.27 Percutaneous cardiovascular procedure without coronary

separately in addition to code for primary procedure) 11.49 Status N, items and artery stent services packaged into MS-DRG 251 without MCC $11,965 primary procedure APC MS-DRG 250 with MCC $17,529

rate. No separate payment 93615 Esophageal recording of atrial electrogram with or without ventricular $53 0.99 APC 84 $873 37.29 ICD-9-CM procedure code does not impact the MS-DRG

electrogram(s) 1.48 93616 Esophageal recording of atrial electrogram with or without ventricular $67 1.49

electrogram(s); with pacing 1.86 93618 Induction of arrhythmia by electrical pacing $247 4.25 N/A

6.92 93619 Comprehensive electrohysiologic evaluation with right atrial pacing $425 7.31 APC 85 $4,635 37.26 Percutaneous cardiovascular procedure without coronary

and recording, right ventricular pacing and recording, His bundle 11.88 artery stent recording, including insertion and repositioning of multiple electrode MS-DRG 251 without MCC $11,965 catheters, without induction or attempted induction of arrhythmia MS-DRG 250 with MCC $17,529

Note: BSC currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation.

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Intracardiac Electrophysiology Procedures/Studies continued go to APC list go to ICD-9-CM list 93620 Comprehensive electrophysiologic evaluation including insertion and $675 N/A 11.75 Not APC 85 $4,635 37.26 Percutaneous cardiovascular procedure without coronary

repositioning of multiple electrode catheters with induction or 18.89 covered artery stent attempted induction of arrhythmia; with right atrial pacing and for ASC MS-DRG 251 without MCC $11,965 recording, right ventricular pacing and recording, His bundle recording payment MS-DRG 250 with MCC $17,529 + 93621 Comprehensive electrophysiologic evaluation including insertion and $123 2..10 Status N, items and

repositioning of multiple electrode catheters with induction or 3.44 services packaged into attempted induction of arrhythmia; with left atrial pacing and recording primary procedure APC from coronary sinus or left atrium (List separately in addition to code rate. No separate for primary procedure) payment

+ 93622 Comprehensive electrophysiologic evaluation including insertion and $179 3.10

repositioning of multiple electrode catheters with induction or 5.02 attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure) + 93623 Programmed stimulation and pacing after intravenous drug infusion $168 2.85

(List separately in addition to code for primary procedure) 4.69 93624 Electrophysiologic follow-up study with pacing and recording to test $270 4.80 APC 85 $4,635

effectiveness of therapy, including induction or attempted induction of 7.55 arrhythmia 93640 Electrophysiologic evaluation of single or dual chamber implantable $202 3.51 Status N, items and not coded ICD-9-CM procedure code does not impact the MS-DRG

defibrillator leads including defibrillation threshold evaluation 5.66 services packaged into at time of device (induction of arrhythmia, evaluation of sensing and pacing for primary procedure APC implant arrhythmia termination) at time of initial implantation or replacement; rate. No separate payment 93641 Electrophysiologic evaluation of single or dual chamber implantable $344 5.92

defibrillator leads including defibrillation threshold evaluation 9.62 (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter- defibrillator pulse generator 93642 Electrophysiologic evaluation of single or dual chamber transvenous $153 4.88 APC 84 $873 37.20

pacing cardioverter-defibrillator (includes defibrillation threshold 7.84 evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

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Intracardiac Electrophysiology Procedures/Studies continued go to APC list go to ICD-9-CM list 93650 Intracardiac catheter ablation of atrioventricular node function, $625 N/A 10.49 Not APC 85 $4,635 37.34 Percutaneous cardiovascular procedure without coronary

atrioventricular conduction for creation of completer heart block, with 17.47 covered 37.78 artery stent or without temporary pacemaker placement for ASC MS-DRG 251 without MCC $11,965 payment 93653 Comprehensive electrophysiologic evaluation including insertion and $879 15.00 APC 86 $14,362 37.26 MS-DRG 250 with MCC $17,529

repositioning of multiple electrode catheters with induction or 24.58 37.27 attempted induction of an arrhythmia with right atrial pacing and 37.28 recording, right ventricular pacing and recording (when necessary) 37.34 and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry 93654 Comprehensive electrophysiologic evaluation including insertion and $1,169 20.00 repositioning of multiple electrode catheters with induction or 32.70 attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary) and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed + 93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia $439 7.50 Status N, items and which is distinct from the primary ablated mechanism, including repeat 12.28 services packaged into diagnostic maneuvers, to treat a spontaneous or induced arrhythmia primary procedure APC (List separately in addition to code for primary procedure) rate. No separate payment 93656 Comprehensive electrophysiologic evaluation including transseptal $1,174 20.02 APC 86 $14,362 catheterizations, insertion and repositioning of multiple electrode 32.84 catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation + 93657 Additional linear or focal intracardiac catheter ablation of the left or $439 7.50 Status N, items and right atrium for treatment of atrial fibrillation remaining after completion 12.27 services packaged into of pulmonary vein isolation (list separately in addition to code for primary procedure APC primary procedure) rate. No separate payment 93660 Evaluation of cardiovascular function with tilt table evaluation, with $95 $159 1.89 APC 96 $329 89.54

continuous ECG monitoring and intermittent blood pressure 4.46 89.59 monitoring, with or without pharmacological intervention 89.68

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Intracardiac Electrophysiology Procedures/Studies continued go to APC list go to ICD-9-CM list + 93662 Intracardiac echocardiography during therapeutic/diagnostic $147 N/A 2.80 Not 37.28 ICD-9-CM procedure code does not impact the MS-DRG

intervention, including imaging supervision and interpretation (list 4.14 covered plus primary separately in addition to code for primary procedure) for ASC procedure payment

Note: Some of the codes presented above may be used to code for a variety of procedures (diagnostic and therapeutic) employed in the field of electrophysiology, including atrial fibrillation, atrial flutter, AV Node, SVT and VT ablations. Please note that no Boston Scientific products are approved for sale in the US for atrial fibrillation ablations. 1 Current Procedural Terminology (CPT) CPT® Copyright 2014 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. 2 Source: CMS website. Physician Fee Schedule – CY 2015 release, http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html 3 Source: CMS website. Final Rule CY2015 ASC Regulations and Notices http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html 4 Source: CMS website. CY2015 OPPS Addendum B http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates-Items/2015-Jan-Addendum-B.html 5 Source: The Educational Annotation of ICD-9-CM; Channel Publishing Ltd; Copyright 2012 Craig D. Puckett, Fifth Edition 6 Source: Data tables (FY2015 IPPS Final Rule). CMS Website. National average (wage index greater than one) MS- DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital amounts . Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, and/or proportion of low-income patients). http://wwwl http://www.cms.gov/Medicare/Medicare-Fee- for-Service-Payment/AcuteInpatientPPS/FY2015-IPPS-Final-Rule-Home-Page.html 8 Total RVU is the relative value unit total for In-Facility calculation

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407 -AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options. Inpatient information effective through September 30, 2015 | APC Information effective through December 31, 2015 | Physician fee information effective through March 31, 2015. *National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547. HOSPITAL HOSPITAL *PHYSICIAN2 OUTPATIENT INPATIENT CPT® In- Work RVU APC APC Possible Possible MS-DRG Code1 CPT Descriptions Hospital2 Total RVU9 Category Payment3 ICD-9-CM Codes4 MS-DRG Assignment Payment5 Diagnostic Cardiac Catheterization (Use physician modifier -26 as appropriate) go to APC list go to ICD-9-CM list 93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, $149 2.72 APC 80 $2,576 37.21 Cardiac valve and other major cardiothoracic procedures

right when performed 4.18 37.22 with cardiac catheterization 37.23 MS-DRG 216 with MCC $55,862 93530 Right heart catheterization, for congenital cardiac anomalies $232 4.22 38.91 MS-DRG 217 with CC $37,123 right 6.50 88.50 88.53 MS-DRG 218 without CC/MCC $32,667 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging $263 4.75

left supervision and interpretation, when performed 7.35 Cardiac defibrillator implant with cardiac catheterization with AMI/HF/Shock 93462 Left heart catheterization by transseptal puncture through intact septum or by transapical $216 3.73 6 MS-DRG 222 with MCC $50,777 left puncture (List separately in addition to code for primary procedure) 6.03 MS-DRG 223 without MCC6 $36,908 93453 Combined right heart catheterization and left heart catheterization including intraprocedural $346 6.24

combined injection(s) for left ventriculography, imaging supervision and interpretation, when performed 9.67 Cardiac defibrillator implant with cardiac catheterization without AMI/HF/Shock 93531 Combined right heart catheterization and retrograde left heart catheterization, for congenital $454 8.34 6 MS-DRG 224 with MCC $45,008 combined cardiac anomalies 12.69 MS-DRG 225 without MCC6 $34,378 93532 Combined right heart catheterization and transseptal left heart catheterization through intact $561 9.99 Coronary bypass with cardiac catheterization combined septum, with or without retrograde left heart catheterization, for congenital cardiac anomalies 15.70 MS-DRG 233 with MCC $43,107 93533 Combined right heart catheterization and transseptal left heart catheterization through existing $376 6.69 MS-DRG 234 without MCC $28,633 combined septal opening, with or without retrograde left heart catheterization, for congenital cardiac 10.53 anomalies) Circulatory disorders except AMI with cardiac catheterization MS-DRG 286 with MCC $12,458 MS-DRG 287 without MCC $6,622

Atherosclerosis MS-DRG 302 with MCC $6,048 MS-DRG 303 without MCC $3,579

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $265 4.79 APC 80 $2,575 37.21 Cardiac valve and other major cardiothoracic procedures

placement injection(s) for coronary angiography, imaging supervision and interpretation 37.22 with cardiac catheterization 7.40 37.23 MS-DRG 216 with MCC $55,862 38.91 93455 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $306 5.54 88.50 MS-DRG 217 with CC $37,123 injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement 8.57 88.53 placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including MS-DRG 218 without CC/MCC $32,667 intraprocedural injection(s) for bypass graft angiography Cardiac defibrillator implant with cardiac catheterization 93456 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $340 6.15 with AMI/HF/Shock

injection(s) for coronary angiography, imaging supervision and interpretation; with right heart 6 placement 9.52 MS-DRG 222 with MCC $50,777 catheterization MS-DRG 223 without MCC6 $36,908 93457 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $380 6.89 injection(s) for coronary angiography, imaging supervision and interpretation; with catheter Cardiac defibrillator implant with cardiac catheterization placement 10.64 placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including without AMI/HF/Shock intraprocedural injection(s) for bypass graft angiography and right heart catheterization MS-DRG 224 with MCC6 $45,008 6 93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $322 5.85 MS-DRG 225 without MCC $34,378 injection(s) for coronary angiography, imaging supervision and interpretation; with left heart placement 9.01 catheterization including intraprocedural injection(s) for left ventriculography, when performed Coronary bypass with cardiac catheterization MS-DRG 233 with MCC $43,107 93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $363 6.60 MS-DRG 234 without MCC $28,633 injection(s) for coronary angiography, imaging supervision and interpretation; with left heart placement 10.16 catheterization including intraprocedural injection(s) for left ventriculography, when performed, Circulatory disorders except AMI with cardiac catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with catheterization bypass graft angiography MS-DRG 286 with MCC $12,458 93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $405 7.35 MS-DRG 287 without MCC $6,622 injection(s) for coronary angiography, imaging supervision and interpretation; with right and left placement 11.34 heart catheterization including intraprocedural injection(s) for left ventriculography, when Atherosclerosis performed MS-DRG 302 with MCC $6,048 93461 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural $448 8.10 MS-DRG 303 without MCC $3,579 injection(s) for coronary angiography, imaging supervision and interpretation; with right and left placement 12.52 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

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

93463 Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, $101 2.00 rate. No separate dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, payment 2.82 during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure)

93564 Injection procedure during cardiac catheterization including imaging supervision and interpretation, $64 1.13 and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, 1.79 aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure)

93565 Injection procedure during cardiac catheterization including imaging supervision and interpretation, $48 0.86 and report; for selective left ventricular or left arterial angiography (List separately in addition to 1.34 code for primary procedure)

93566 Injection procedure during cardiac catheterization including imaging supervision and interpretation, $48 0.86 and report; for selective right ventricular or right atrial angiography (List separately in addition to 1.34 code for primary procedure)

93567 Injection procedure during cardiac catheterization including imaging supervision and interpretation, $54 0.97 and report; for supravalvular aortography (List separately in addition to code for primary 1.52 procedure)

93568 Injection procedure during cardiac catheterization including imaging supervision and interpretation, $49 0.88 and report; for pulmonary angiography (List separately in addition to code for primary procedure) 1.37

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

Coronary Angioplasty (PTCA), without Stent go to APC list go to ICD-9-CM list 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch APC 83 $4,539 00.66 Percutaneous cardiovascular procedures without $566 10.10 coronary artery stent 15.84 MS-DRG 250 with MCC $17,529 + 92921 Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery $0 0.00 N/A $11,965 MS-DRG 251 without MCC (list separately in addition to code for primary procedure) 0.00

Coronary Atherectomy, without Stent 92924 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; APC 229 $9,627 17.55 Percutaneous cardiovascular procedures without $672 11.99 single major coronary artery or branch coronary artery stent 18.79 MS-DRG 250 with MCC $17,529 + 92925 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; $0 0.00 N/A MS-DRG 251 without MCC $11,965

each additional branch of a major coronary artery (list separately in addition to code for primary 0.00 procedure)

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when APC 229 $9,627 00.66 Percutaneous cardiovascular procedures with non-drug- $628 11.21 performed; single major coronary artery or branch eluting stent 17.57 36.06 Code Also MS-DRG 248 with MCC $17,838 + 92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when $0 0.00 N/A 00.40-00.44 MS-DRG 249 without MCC $11,032

performed; each additional branch of a major coronary artery (list separately in addition to code for 0.00 primary procedure) and 00.45-00.48 Drug-eluting Coronary Stent with Angioplasty

C9600 Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary N/A APC 229 $9,627 00.66 Percutaneous cardiovascular procedures with drug-

angioplasty when performed; single major coronary artery or branch Physicians use codes 36.07 eluting stent 92928 / + 92929 MS-DRG 246 with MCC $18,985 + C9601 Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary N/A Code Also angioplasty when performed; each additional branch of major coronary artery 00.40-00.44 MS-DRG 247 without MCC $12,075 and 00.45-00.48 Bare Metal Coronary Stent with Atherectomy

92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary APC 319 $14,846 17.55 Percutaneous cardiovascular procedures with non-drug- $703 12.54 angioplasty when performed; single major coronary artery or branch eluting stent 19.66 36.06 Code Also MS-DRG 248 with MCC $17,838 + 92934 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary $0 0.00 N/A 00.40-00.44 MS-DRG 249 without MCC $11,032

angioplasty when performed; each additional branch of a major coronary artery (list separately in 0.00 and 00.45-00.48 addition to code for primary procedure Drug-eluting Coronary Stent with Atherectomy

C9602 Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with N/A APC 319 $14,846 17.55 Percutaneous cardiovascular procedures with drug-

coronary angioplasty when performed; single major coronary artery or branch Physicians use codes 36.07 eluting stent 92933 / + 92934 Code Also MS-DRG 246 with MCC $18,985 + C9603 Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with N/A coronary angioplasty when performed; each additional branch of a major coronary artery 00.40-00.44 MS-DRG 247 without MCC $12,075 and 00.45-00.48

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and 0.00 00.40-00.44 angioplasty, including distal protection when performed; each additional branch subtended by the and 00.45-00.48 bypass graft (list separately in addition to code for primary procedure) Drug-eluting Stent - Bypass Graft Revascularization C9604 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal N/A APC 229 $9,627 00.66 Percutaneous cardiovascular procedures with drug- 17.55 mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy Physicians use codes eluting stent 36.07 and angioplasty, including distal protection when performed; single vessel 92937 / + 92938 MS-DRG 246 with MCC $18,985 Code Also + C9605 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal N/A MS-DRG 247 without MCC $12,075

00.40-00.44 mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and 00.45-00.48 and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft Bare Metal Stent - Acute Myocardial Infarction Revascularization 92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute APC 229 $9,627 00.66 Percutaneous cardiovascular procedures with non-drug-

$704 12.56 myocardial infarction, coronary artery or coronary artery bypass graft, any combination of eluting stent 19.69 17.55 intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when 36.06 MS-DRG 248 with MCC $17,838 performed, single vessel Code Also MS-DRG 249 without MCC $11,032 00.40-00.44 and 00.45-00.48 Drug-eluting Stent - Acute Myocardial Infarction Revascularization C9606 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute N/A APC 319 $14,846 00.66 Percutaneous cardiovascular procedures with drug-

myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug- Physicians use code 17.55 eluting stent eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when 36.07 92941 MS-DRG 246 with MCC $18,985 performed, single vessel Code Also MS-DRG 247 without MCC $12,075

00.40-00.44 and 00.45-00.48

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy 0.00 00.40-00.44 and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list and 00.45-00.48 separately in addition to code for primary procedure) Drug-eluting Stent - Chronic Total Occlusion Revascularization C9607 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary N/A APC 319 $14,846 00.66 Percutaneous cardiovascular procedures with drug- 17.55 artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, Physicians use codes eluting stent 36.07 atherectomy and angioplasty; single vessel 92943 / + 92944 MS-DRG 246 with MCC $18,985 Also code + C9608 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary N/A MS-DRG 247 without MCC $12,075

00.40-00.44 artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, and 00.45-00.48 atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

*National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547. HOSPITAL HOSPITAL *PHYSICIAN2 OUTPATIENT INPATIENT CPT® In- Work RVU APC APC Possible Possible MS-DRG Code1 CPT Descriptions Hospital2 Total RVU9 Category Payment3 ICD-9-CM Codes4 MS-DRG Assignment Payment5 Intravascular Ultrasound (Use physician modifier-26 as appropriate) go to APC list go to ICD-9-CM list 92978 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic $101 1.80 Status N, Items and 00.24 Coronary bypass with PTCA intervention including imaging supervision, interpretation and report; initial vessel (List separately Services packaged into 00.28 2.83 MS-DRG 231 with MCC $45,309 in addition to code for primary procedure) primary procedure APC 00.29 rate. No separate MS-DRG 232 without MCC $32,833 + 92979 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic $81 1.44 payment intervention including imaging supervision, interpretation and report; each additional vessel (List Percutaneous cardiovascular procedure with drug-eluting 2.26 separately in addition to code for primary procedure) stent MS-DRG 246 with MCC or 4+ Fractional Flow Reserve (FFR) (Use physician modifier-26 as appropriate) vessels/stents $18,985 93571 Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement $101 1.80 Status N, Items and 00.59 MS-DRG 247 without MCC $12,075 (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; Services packaged into 00.69 2.83 initial vessel (List separately in addition to code for primary procedure) primary procedure APC Percutaneous cardiovascular procedure with non-drug- rate. No separate + 93572 eluting stent Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement $81 1.44 payment (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; MS-DRG 248 with MCC or 4+ 2.26 each additional vessel (List separately in addition to code for primary procedure) vessels/stents $17,838 MS-DRG 249 without MCC $11,032

Percutaneous cardiovascular procedure without coronary artery stent MS-DRG 250 with MCC $17,529 MS-DRG 251 without MCC $11,965

Circulatory disorders except AMI, with cardiac catheterization MS-DRG 286 with MCC $12,458 MS-DRG 287 without MCC $6,622

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

Percutaneous cardiovascular procedure with non-drug- eluting stent MS-DRG 248 with MCC or 4+ vessels/stents $17,838 MS-DRG 249 without MCC $11,032

Percutaneous cardiovascular procedure without coronary artery stent MS-DRG 250 with MCC $17,529 MS-DRG 251 without MCC $11,965

Circulatory disorders except AMI, with cardiac catheterization MS-DRG 286 with MCC $12,458 MS-DRG 287 without MCC $6,622

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

Percutaneous Balloon Valvuloplasty; Aortic Valve go to APC list go to ICD-9-CM list 92986 Percutaneous balloon valvuloplasty; aortic valve APC 83 $4,539 35.96 Coronary bypass with PTCA $1,381 22.85

$$45,309 38.63 MS-DRG 231with MCC

MS-DRG 232 without MCC $32,833 92987 Percutaneous balloon valvuloplasty; mitral valve APC 229 $9,627 $1,424 23.63 Percutaneous cardiovascular procedure with drug-eluting 39.82 stent 92990 Percutaneous balloon valvuloplasty; pulmonary valve APC 229 $9,627 MS-DRG 246 with MCC or 4+ $1,127 18.27 vessels/stents $18,985 31.52 MS-DRG 247 without MCC $12,075

Percutaneous cardiovascular procedures with non-drug- eluting stent MS-DRG 248 with MCC or 4+ vessels/stents $17,838 MS-DRG 249 without MCC $11,032

Percutaneous cardiovascular procedure without coronary artery stent MS-DRG 250 with MCC $17,529 MS-DRG 251 without MCC $11,965

Circulatory disorders except AMI, with cardiac catheterization MS-DRG 286 with MCC $12,458 MS-DRG 287 without MCC $6,622

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

Endovascular or Transthoracic Valves go to APC list go to ICD-9-CM list

33361 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; percutaneous femoral $1,414 25.13 N/A 35.05 Cardiac valve and other major cardiothoracic procedures artery approach Aortic 39.54 Inpatient Only 35.06 with cardiac catheterization Procedure 35.09 MS-DRG 216 with MCC $55,862 33362 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open femoral artery $1,546 27.52

Aortic approach 43.23 MS-DRG 217 with CC $37,123

33363 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open axillary artery $1,623 28.50 MS-DRG 218 without CC/MCC $32,667

Aortic approach 45.40 Cardiac valve and other major cardiothoracic procedures 33364 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open iliac artery approach $1,683 30.00 without cardiac catheterization

Aortic 47.06 MS-DRG 219 with MCC $45,928 33365 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transaortic approach (e.g., $1,852 33.12 MS-DRG 220 with CC $30,690 median sternotomy, mediastinotomy) Aortic 51.81 MS-DRG 221 without CC/MCC $26,924 33366 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure $2,005 35.88 39.61 Major cardiovascular procedure Aortic (eg, left thoracotomy) 56.08 MS-DRG 237 with MCC $29,556 + 33367 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass $650 11.88 MS-DRG 238 without MCC $19,473 support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (list 18.17 Aortic separately in addition to code for primary procedure) Endovascular cardiac valve replacement + 33368 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass $780 14.39 support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary MS-DRG 266 with MCC $52,742 21.82 Aortic vessels) (list separately in addition to code for primary procedure) MS-DRG 267 without MCC $39,602

+ 33369 Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass $1,030 19.00 35.06

support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) 28.80 Aortic (list separately in addition to code for primary procedure) 0262T Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach Carrier N/A 35.07 Pulmonary Priced 35.09 33999 Unlisted procedure, cardiac surgery APC 70 $489 35.08

35.09 93799 Unlisted cardiovascular service or procedure APC 97 $113 35.97 Percutaneous cardiovascular procedure without coronary

35.09 artery stent MS-DRG 250 with MCC $17,529 MS-DRG 251 without MCC $11,965

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See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Coronary Interventions 2015 Procedural Payment Guide

1 Current Procedural Terminology (CPT) © 2014 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. 2 Source: CMS Physician Fee Schedule – CY 2015 release http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html 3 Source: CMS website. CY2015 OPPS Addendum B http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates-Items/2015-Jan-Addendum-B.html 4 Source: The Educational Annotation of ICD-9-CM; Channel Publishing Ltd; Copyright 2012 Craig D. Puckett, Fifth Edition 5 Source: Data tables (FY2015 IPPS Final Rule). CMS Website. National average (wage index greater than one) MS- DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital amounts. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, and/or proportion of low-income patients). http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/AcuteInpatientPPS/FY2015-IPPS-Final-Rule-Home-Page.html 6 Not intended as an all inclusive list of MS-DRGs. 7 Procedure codes do not exist for this procedure because it does not drive the MS-DRG grouping. 8 MS-DRG grouping is driven by other primary procedures that are performed in conjunction with this procedure. 9 Total RVU is the relative value unit total for In-Facility calculation

2-12

See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options. Inpatient information effective through September 30, 2015 | APC and ASC Information effective through December 31, 2015 | Physician fee information effective through March 31, 2015. *National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547. HOSPITAL HOSPITAL *PHYSICIAN2 ASC3 OUPATIENT4 INPATIENT6 Work RVU ASC APC APC Possible Possible CPT® Code1 CPT Descriptions In-Hospital In-Office Total RVU9 Payment Category Payment4 ICD-9-CM Code5 MS-DRG Assignment MS-DRG Payment6

Peripheral Percutaneous Transluminal Balloon Angioplasty go to APC list go to ICD-9-CM list

35471 Transluminal balloon angioplasty, percutaneous; renal or visceral artery APC 83 $4,539 39.50 Other vascular procedures $548 $2,605 10.05 N/A

15.32 MS-DRG 252 with MCC $19,148 MS-DRG 253 with CC $14,976 35472 Transluminal balloon angioplasty, percutaneous; aortic $376 $1,907 6.90 MS-DRG 254 without CC/MCC $10,150 10.51

35475 Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or $350 $1,588 6.60 $1,317 branches, each vessel 9.78

35476 Transluminal balloon angioplasty, percutaneous; venous $283 $1,452 5.10 $1,242

7.91 Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate) 75962 Transluminal balloon angioplasty, peripheral artery other than cervical $26 $139 0.54 N/A Status N, items and N/A7 N/A8 carotid, renal or other visceral artery, iliac and lower extremity, services packaged into 3.89 radiological supervision and interpretation primary procedure APC rate. No separate 75964 Transluminal balloon angioplasty, each additional peripheral artery other $18 $87 0.36 payment than cervical carotid, renal or other visceral artery iliac and lower 2.42 extremity, radiological supervision and interpretation (List separately in addition to code for primary procedure) 75966 Transluminal balloon angioplasty, renal or other visceral artery, $65 $172 1.31

radiological supervision and interpretation. 4.82 75968 Transluminal balloon angioplasty, each additional visceral artery, $18 $89 0.36

radiological supervision and interpretation (List separately in addition to 2.49 code for primary procedure) 75978 Transluminal balloon angioplasty, venous (eg, subclavian stenosis), $26 $138 0.54 APC 93 $2,501

radiological supervision and interpretation 3.85

3-1 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Iliac Artery Revascularization go to APC list go to ICD-9-CM list 37220 Revascularization, endovascular, open or percutaneous, iliac artery, $437 $3,215 8.15 $2,220 APC 83 $4,539 39.50 Other vascular procedures unilateral, initial vessel; with transluminal angioplasty 12.23 MS-DRG 252 with MCC $19,148

MS-DRG 253 with CC $14,976 37221 Revascularization, endovascular, open or percutaneous, iliac artery, $537 $4,741 10.00 $6,061 APC 229 $9,627 39.50 MS-DRG 254 without CC/MCC $10,150 unilateral, initial vessel; with transluminal stent placement(s), includes 15.02 39.90 angioplasty within same vessel, when performed 37222 Revascularization, endovascular, open or percutaneous, iliac artery, each $197 $902 3.73 $2,436 Status N, items and 39.50

additional ipsilateral iliac vessel; with transluminal angioplasty (List 5.51 services packaged into separately in addition to code for primary procedure) primary procedure APC rate. No separate 37223 Revascularization, endovascular, open or percutaneous, iliac artery, each $226 $2,642 4.25 39.50 payment additional ipsilateral iliac vessel; with transluminal stent placement(s), 6.33 39.90 includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) Femoral/Popliteal Artery Revascularization 37224 Revascularization, endovascular, open or percutaneous, femoral/popliteal $482 $3,901 9.00 $2,220 APC 83 $4,539 39.50 Other vascular procedures artery(s), unilateral; with transluminal angioplasty 13.48 MS-DRG 252 with MCC $19,148

MS-DRG 253 with CC $14,976 37225 Revascularization, endovascular, open or percutaneous, femoral/popliteal $651 $11,220 12.00 $6,061 APC 229 $9,627 39.50 MS-DRG 254 without CC/MCC $10,150

artery(s), unilateral; with atherectomy, includes angioplasty within the 18.21 39.90 same vessel, when performed 37226 Revascularization, endovascular, open or percutaneous, femoral/popliteal $566 $9,227 10.49

artery(s), unilateral; with transluminal stent placement(s), includes 15.83 angioplasty within the same vessel, when performed 37227 Revascularization, endovascular, open or percutaneous, femoral/popliteal $783 $15,151 14.50 $9,740 APC 319 $14,846

artery(s), unilateral; with transluminal stent placement(s) and 21.90 atherectomy, includes angioplasty within the same vessel, when performed

NOTE: BSC has no stents FDA-approved for use in the infrainguinal regions of the lower extremities.

3-2 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Tibial/Peroneal Artery Revascularization go to APC list go to ICD-9-CM list 37228 Revascularization, endovascular, open or percutaneous, tibial\peroneal $588 $5,547 11.00 $6,061 APC 229 $9,628 39.50 Other vascular procedures artery, unilateral, initial vessel; with transluminal angioplasty 16.45 MS-DRG 252 with MCC $19,148 37229 Revascularization, endovascular, open or percutaneous, tibial\peroneal $760 $11,069 14.05 $9,740 APC 319 $14,846 MS-DRG 253 with CC $14,976

artery, unilateral, initial vessel; with atherectomy, includes angioplasty 21.25 within the same vessel, when performed MS-DRG 254 without CC/MCC $10,150

37230 Revascularization, endovascular, open or percutaneous, tibial\peroneal $749 $8,464 13.80 39.50

artery, unilateral, initial vessel; with transluminal stent placement(s), 20.96 39.90 includes angioplasty within the same vessel, when performed 37231 Revascularization, endovascular, open or percutaneous, tibial\peroneal $814 $13,598 15.00

artery, unilateral, initial vessel; with transluminal stent placement(s) and 22.78 atherectomy, includes angioplasty within the same vessel, when performed 37232 Revascularization, endovascular, open or percutaneous, tibial\peroneal $213 $1,238 4.00 $2,436 Status N, items and

artery, unilateral, each additional vessel; with transluminal angioplasty. 5.97 services packaged into (List separately in addition to code for primary procedure) primary procedure APC rate. No separate 37233 Revascularization, endovascular, open or percutaneous, tibial\peroneal $347 $1,497 6.50 $5,038 39.50 payment artery, unilateral, each additional vessel; with atherectomy, includes 9.70 angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure) 37234 Revascularization, endovascular, open or percutaneous, tibial\peroneal $300 $3,947 5.50 $2,436 39.50

artery, unilateral, each additional vessel; with transluminal stent 8.39 39.90 placement(s), includes angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure) 37235 Revascularization, endovascular, open or percutaneous, tibial\peroneal $421 $4,239 7.80

artery, unilateral, each additional vessel; with transluminal stent 11.53 placement(s) and atherectomy, includes angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure

NOTE: BSC has no stents FDA-approved for use in the infrainguinal regions of the lower extremities.

3-3 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

*National Average Medicare physician payment rates calculated using the 2015 conversion factor of $35.7547. HOSPITAL HOSPITAL *PHYSICIAN2 ASC3 OUPATIENT4 INPATIENT6 Work RVU ASC APC APC Possible Possible CPT® Code1 CPT Descriptions In-Hospital In-Office Total RVU9 Payment Category Payment4 ICD-9-CM Code5 MS-DRG Assignment MS-DRG Payment6 Transcatheter Placement of Intravascular Stents (Peripheral stenting is covered at local Medicare contractor discretion. Payment amounts assume procedure is covered.) go to APC list go to ICD-9-CM list

37236 Transcatheter placement of an intravascular stent(s) (except lower $477 $4,221 9.00 $6,061 APC 229 $9,627 39.50 Other vascular procedures

extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, 13.35 39.90 MS-DRG 252 with MCC $19,148

intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the MS-DRG 253 with CC $14,976 same vessel, when performed; initial artery MS-DRG 254 without CC/MCC $10,150

37237 Transcatheter placement of an intravascular stent(s) (except lower $227 $2,530 4.25 N/A Status N, items and

extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, 6.34 Packaged services packaged into intracranial, or coronary), open or percutaneous, including radiological service, no primary procedure APC supervision and interpretation and including all angioplasty within the separate rate. No separate same vessel, when performed; each additional artery (List separately in payment payment addition to code for primary procedure) 37238 Transcatheter placement of an intravascular stent(s), open or $334 $4,184 6.29 $6,601 APC 229 $9,627

percutaneous, including radiological supervision and interpretation and 9.35 including angioplasty within the same vessel, when performed; initial vein 37239 Transcatheter placement of an intravascular stent(s), open or $158 $2,065 2.97 N/A Status N, items and

percutaneous, including radiological supervision and interpretation and 4.43 Packaged services packaged into including angioplasty within the same vessel, when performed; each service, no primary procedure APC additional vein (List separately in addition to code for primary procedure) separate rate. No separate payment payment Transcatheter Placement of Carotid Stents with embolic protection (Boston Scientifics’ carotid WALLSTENT® Monorail® Endoprosthesis device is indicated for carotid artery stenting with embolic protection only. Medicare will not consider payment for the procedure when performed without embolic protection.) 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, $1,141 N/A 19.68 N/A N/A 00.61 Carotid artery stent procedure percutaneous; with distal embolic protection Inpatient only procedure 00.63 31.90 MS-DRG 034 with MCC $21,707 37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, $0 0.00 N/A MS-DRG 035 with CC $12,698 percutaneous; without distal embolic protection Not paid by Medicare 0.00 MS-DRG 036 without CC/MCC $9,989

3-4 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Embolization go to APC list go to ICD-9-CM list 37241 Vascular embolization or occlusion, inclusive of all radiological $464 $4,673 9.00 N/A APC 229 $8,843 38.7 Other vascular procedures supervision and interpretation, intraprocedural roadmapping, and imaging 12.98 MS-DRG 252 with MCC $19,148 guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous MS-DRG 253 with CC $14,976 and capillary hemangiomas, varices, varicoceles) MS-DRG 254 without CC/MCC $10,150

37242 Vascular embolization or occlusion, inclusive of all radiological $517 $7,877 10.05

supervision and interpretation, intraprocedural roadmapping, and imaging 14.47 guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms) 37243 Vascular embolization or occlusion, inclusive of all radiological $616 $9,943 11.99 supervision and interpretation, intraprocedural roadmapping, and imaging 17.24 guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction 37244 Vascular embolization or occlusion, inclusive of all radiological $719 $6,959 14.00 supervision and interpretation, intraprocedural roadmapping, and imaging 20.12 guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Catheter Access 7 8 36140 Introduction of needle or intracatheter; extremity artery $107 $445 2.01 Status N, items and N/A N/A N/A

3.00 services packaged into primary procedure APC rate. 36147 Introduction of needle and/or catheter, arteriovenous shunt created for $195 $850 3.72 $453 APC 668 $827

dialysis (graft/fistula); initial access with complete radiological evaluation 5.44 of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow, including the inferior or superior vena cava) 36148 Introduction of needle and/or catheter, arteriovenous shunt created for $51 $266 1.00 N/A Status N, items and

dialysis (graft/fistula); additional access for therapeutic intervention (List 1.44 services packaged into separately in addition to code for primary procedure) primary procedure APC rate. No separate 36160 Introduction of needle or intracatheter, aortic, translumbar $129 $504 2.52

payment 3.62

36200 Introduction of catheter, aorta $161 $636 3.02 4.50

3-5 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Catheter Placement go to APC list go to ICD-9-CM list

36215 Selective catheter placement, arterial system; each first order thoracic or $246 $1,146 Status N, items and N/A7 N/A8 4.67 N/A brachiocephalic branch, within a vascular family services packaged into 6.89 primary procedure APC 36216 Selective catheter placement, arterial system; initial second order thoracic $286 $1,192 5.27 rate. No separate

or brachiocephalic branch, within a vascular family 8.00 payment 36217 Selective catheter placement, arterial system; initial third order or more $339 $1,927 6.29

selective thoracic or brachiocephalic branch, within a vascular family 9.49 36218 Selective catheter placement, arterial system; additional second order, $55 $188 1.01

third order, and beyond, thoracic or brachiocephalic branch, within a 1.53 vascular family (List in addition to code for initial second or third order vessel as appropriate) 36245 Selective catheter placement, arterial system; each first order abdominal, $264 $1,393 4.90

pelvic, or lower extremity artery branch, within a vascular family 7.38 36246 Selective catheter placement, arterial system; initial second order $282 $909 5.27

abdominal, pelvic, or lower extremity artery branch, within a vascular 7.88 family 36247 Selective catheter placement, arterial system; initial third order or more $333 $1,605 6.29

selective abdominal, pelvic, or lower extremity artery branch, within a 9.32 vascular family 36248 Selective catheter placement, arterial system; additional second order, $51 $156 1.01

third order, and beyond, abdominal, pelvic, or lower extremity artery 1.44 branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

3-6 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Catheter Placement continued go to APC list go to ICD-9-CM list

36251 Selective catheter placement (first-order), main renal artery and any $295 $1,448 N/A APC 279 $2,560 N/A7 N/A8 5.35 accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), 8.24 image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; unilateral. 36252 Selective catheter placement (first-order), main renal artery and any $392 $1,573 6.99

accessory renal artery(s) for renal angiography, including arterial 10.95 puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; bilateral. 36253 Superselective catheter placement (one or more second order or higher $394 $2,306 7.55

renal artery branches), renal artery and any accessory renal artery(s) for 11.03 renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; unilateral. 36254 Superselective catheter placement (one or more second order or higher $454 $2,244 8.15

renal artery branches), renal artery and any accessory renal artery(s) for 12.71 renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; bilateral.

3-7 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Angiography (Use physician modifier -26 as appropriate) go to APC list go to ICD-9-CM list

75710 Angiography, extremity, unilateral, radiological supervision and $55 $162 APC 279 $2,559 88.45 N/A8 1.14 N/A interpretation 4.53 88.47 88.48 75716 Angiography, extremity, bilateral, radiological supervision and $66 $188 1.31 88.49 interpretation 5.25

75726 Angiography, visceral, selective or supraselective (with or without flush $58 $151 1.14

aortogram), radiological supervision and interpretation 4.23 75731 Angiography, adrenal, unilateral, selective, radiological supervision and $58 $172 1.14 interpretation 4.80

75733 Angiography, adrenal, bilateral, selective, radiological supervision and $65 $184 1.31

interpretation 5.14 75736 Angiography, pelvic, selective or supraselective, radiological supervision $59 $164 1.14

and interpretation 4.59 75774 Angiography, selective, each additional vessel studied after basic $18 $88 0.36 examination, radiological supervision and interpretation (List separately in 2.47 addition to code for primary procedure)

Transhepatic Shunts (TIPS)

37182 Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) $873 N/A N/A 39.10 Major cardiovascular procedures 16.97 N/A (includes venous access, hepatic and portal vein catheterization, MS-DRG 237 with MCC or thoracic portography with hemodynamic evaluation, intrahepatic tract 24.42 aortic aneurysm repair $29,556 formation/dilatation, stent placement and all associated imaging guidance and documentation) MS-DRG 238 without MCC $19,473

37183 Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) $412 $6,010 7.99 APC 083 $4,539

(includes venous access, hepatic and portal vein catheterization, 11.52 portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation)

3-8 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Arteriovenous Fistual Thrombectomy go to APC list go to ICD-9-CM list

36870 Thrombectomy, percutaneous, arteriovenous fistula, autogenous or $314 $1,865 5.20 $2,220 APC 83 $4,539 39.49 Other vascular procedures nonautogenous graft (includes mechanical thrombus extraction and intra- 8.77 39.99 MS-DRG 252 with MCC $19,148 graft thrombolysis) MS-DRG 253 with CC $14,976 MS-DRG 254 without CC/MCC $10,150

Arterial Thrombectomy

37184 Primary percutaneous transluminal mechanical thrombectomy, $484 $2,317 8.66 $1,765 APC 88 $3,220 39.79 Major cardiovascular procedures noncoronary, arterial or arterial bypass graft, including fluoroscopic 13.53 MS-DRG 237 with MCC or thoracic guidance and intraprocedural pharmacological thrombolytic injection(s); aortic aneurysm repair $29,822 initial vessel MS-DRG 238 without MCC $20,084 37185 Primary percutaneous transluminal mechanical thrombectomy, $176 $733 3.28 N/A N/A

noncoronary, arterial or arterial bypass graft, including fluoroscopic 4.92 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) 37186 Secondary percutaneous transluminal thrombectomy (eg, nonprimary $261 $1,404 4.92

mechanical, snare basket, suction technique), noncoronary, arterial or 7.30 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)

Venous Thrombectomy

37187 Percutaneous transluminal mechanical thrombectomy, vein(s), including $427 $2,103 8.03 $1,765 APC 88 $3,220 39.79 Major cardiovascular procedures intraprocedural pharmacological thrombolytic injections and fluoroscopic 11.94 MS-DRG 237 with MCC or thoracic guidance aortic aneurysm repair $29,822 37188 Percutaneous transluminal mechanical thrombectomy, vein(s), including $307 $1,795 5.71 MS-DRG 238 without MCC $20,084 intraprocedural pharmacological thrombolytic injections and fluoroscopic 8.59 guidance, repeat treatment on subsequent day during course of thrombolytic therapy

3-9 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Thrombolysis go to APC list go to ICD-9-CM list

37211 Transcatheter therapy, arterial infusion for thrombolysis other than $419 N/A 8 $462 APC 621 $843 39.79 Major cardiovascular procedures

coronary, any method, including radiological supervision and 11.73 MS-DRG 237 with MCC or thoracic interpretation, initial treatment day aortic aneurysm repair $29,822 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, $368 N/A 7.06 APC 621 $843 MS-DRG 238 without MCC $20,084

including radiological supervision and interpretation, initial treatment day 10.28 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other $259 N/A N/A5.00 N/A APC 622 $2,236

than coronary, any method, including radiological supervision and 7.25 interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed 37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other $143 N/A 2.74 N/A APC 622 $2,236

than coronary, any method, including radiological supervision and 3.99 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

3-10 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Vena Cava Filters go to APC list go to ICD-9-CM list

Insertion of intravascular vena cava filter, endovascular approach $250 $2,681 4.71 N/A APC 622 $2,236 38.80 Other vascular procedures 37191 including vascular access, vessel selection, and radiological supervision 7.00 38.91 MS-DRG 252 with MCC $19,148 and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed MS-DRG 253 with CC $14,976 MS-DRG 254 without CC/MCC $10,150 37192 Repositioning of intravascular vena cava filter, endovascular approach $391 $1,711 7.35 including vascular access, vessel selection, and radiological supervision 10.94 and interpretation, intraprocedural roadmapping, and imaging guidance Extensive O.R. procedure unrelated to principal diagnosis (ultrasound and fluoroscopy), when performed MS-DRG 981 with MCC $28,603 MS-DRG 982 with CC $16,531 37193 Retrieval (removal) of intravascular vena cava filter, endovascular $384 $1,633 7.35 approach including vascular access, vessel selection, and radiological 10.73 MS-DRG 983 without CC/ MCC $10,581 supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed Intravascular Ultrasound 37250 Intravascular ultrasound (non-coronary vessel) during diagnostic $112 N/A 2.10 N/A N/A 00.21 Other vascular procedures evaluation and/or therapeutic intervention; initial vessel (List separately in 3.14 00.22 MS-DRG 252 with MCC $19,148 addition to code for primary procedure) 00.23 00.28 MS-DRG 253 with CC $14,976 37251 Intravascular ultrasound (non-coronary vessel) during diagnostic $84 N/A 1.60 00.29 evaluation and/or therapeutic intervention; each additional vessel (List 2.36 MS-DRG 254 without CC/MCC $10,150 separately in addition to code for primary procedure) Peripheral vascular procedures MS-DRG 299 with MCC $8,267 MS-DRG 300 with CC $5,731 MS-DRG 301 without CC/MCC $3,974

Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate) 8 75945 Intravascular ultrasound (non-coronary vessel), radiological supervision $20 $0 0.40 N/A APC 267 $190 00.21 N/A and interpretation; initial vessel 0.57 00.22 00.23 75946 Intravascular ultrasound (non-coronary vessel), radiological supervision $20 $0 0.40 N/A 00.28 and interpretation; each additional non-coronary vessel (List separately in 0.57 00.29 addition to code for primary procedure)

3-11 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Drainage go to APC list go to ICD-9-CM list

47510 Introduction of percutaneous transhepatic catheter for biliary drainage $488 $488 8.03 $1,005 APC 152 $1,833 51.43 Pancreas, liver and shunt procedures

13.64 51.98 MS-DRG 405 with MCC $31,511 51.99 47511 Introduction of percutaneous transhepatic stent for internal and external $597 $597 10.77 $2,245 APC 423 $4,094 MS-DRG 406 with CC $16,046 biliary drainage 16.70 MS-DRG 407 without CC/MCC $11,100

Biliary tract procedures except only cholecystectomy MS-DRG 408 with or without C.D.E. with MCC $23,884 MS-DRG 409 with or without C.D.E. with CC $14,114 MS-DRG 410 with or without C.D.E. without CC/MCC $8,771

47525 Change of percutaneous biliary drainage catheter $88 $529 1.54 $706 APC 427 $1,289 97.05 N/A8

2.45 47530 Revision and/or reinsertion of transhepatic tube $365 $1,402 6.05

10.20

49421 Insertion of intraperitoneal cannula or catheter for drainage or dialysis, $239 $239 $2394.21 $1,254 APC 652 $2,288 51.94

open 6.69

49423 Exchange of previously placed abscess or cyst drainage catheter under $75 $558 1.46 $706 APC 427 $1,289 97.15

radiological guidance (separate procedure) 2.11

50392 Introduction of intracatheter or catheter into renal pelvis for drainage $186 $186 3.37 $672 APC 161 $1,226 55.29 Kidney and ureter procedures for neoplasm and/or injection, percutaneous 5.19 MS-DRG 656 with MCC $20,427 MS-DRG 657 with CC $11,751 MS-DRG 658 without CC/MCC $8,742

Kidney and ureter procedures for non-neoplasm MS-DRG 659 with MCC $19,748 MS-DRG 660 with CC $10,919 MS-DRG 661 without CC/MCC $7,792

3-12 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Drainage continued go to APC list go to ICD-9-CM list Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate) 7 75980 Percutaneous transhepatic biliary drainage with contrast monitoring, $74 $74 1.44 N/A Status N, items and N/A N/A8

radiological supervision and interpretation 2.07 services packaged into primary procedure APC rate. No separate payment 75982 Percutaneous placement of drainage catheter for combined internal and $73 $73 1.44

external biliary drainage or of a drainage stent for internal biliary drainage 2.05 in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

75984 Change of percutaneous tube or drainage catheter with contrast $36 $107 0.72

monitoring (eg, genitourinary system, abscess), radiological supervision 2.99 and interpretation Biliary Stenting 47556 Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of $2,244 51.43 $437 $437 N/A8.55 APC 423 $4,096 Malignancy of hepatobiliary system of pancreas biliary duct stricture(s) with stent 51.98 12.22 MS-DRG 435 with MCC $10,066 51.87 47511 Introduction of percutaneous transhepatic stent for internal and external $597 $597 10.77 MS-DRG 436 with CC $6,697 biliary drainage 16.70 MS-DRG 437 without CC/MCC $5,383 47530 Revision and/or reinsertion of transhepatic tube $706 $365 $1,402 6.05 APC 427 $1,289 Disorders of the biliary tract 10.20 MS-DRG 444 with MCC $9,314 MS-DRG 445 with CC $6,076 MS-DRG 446 without CC/MCC $4,349

Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate)

74363 Percutaneous transhepatic dilation of biliary duct stricture with or without $45 $0 0.88 N/A Status N, items and N/A7 N/A8

placement of stent, radiological supervision and interpretation 1.26 services packaged into primary procedure APC rate. No separate payment

3-13 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

Radiofrequency Ablation go to APC list go to ICD-9-CM list 47370 Laparoscopy, surgical, ablation of 1 or more liver tumor(s); $1,290 $1,290 20.80 N/A APC 174 $8,070 50.23 radiofrequency 36.07 Pancreas, Liver and Shunt Procedures 50.24 MS-DRG 405 with MCC $31,511 47382 Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency 15.22 $2,244 50.25 $803 $5,093 APC 423 $4,096 22.47 MS-DRG 406 with CC $16,046 MS-DRG 407 without CC/MCC $11,100 47380 Ablation, open, of 1 or more liver tumor(s); radiofrequency $1,490 $1,490 24.56 N/A N/A 41.67

Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate) 76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation $108 $0 0.69 N/A Status N, items and N/A7 N/A8

3.01 services packaged into primary procedure APC rate. No separate payment

NOTE: BSC has no stents FDA-approved for use in the infrainguinal regions of the lower extremities.

3-14 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Select Peripheral Interventions 2015 Procedural Payment Guide

3-15 See page i for important information about the uses and limitations if this document. See page i - ii for sources and footnotes. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV -210407-AB FEB2015 Appendix A 2015 Procedural Payment Guide

APC Reference Table

►pages A1-A2

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view APC APC Category Payment APC Description 70 $489 Thoracentesis/Lavage Procedures 80 $2,575 Diagnostic Cardiac Catheterization 83 $4,539 Level I Endovascular Procedures 84 $873 Level I Electrophysiologic Procedures 85 $4,635 Level II Electrophysiologic Procedures 86 $14,362 Level III Electrophysiologic Procedures 88 $3,221 Thrombectomy 89 $9,493 Level III Pacemaker and Similar Procedures 90 $6,545 Level II Pacemaker and Similar Procedures 93 $2,501 Vascular Reconstruction/Fistula Repair 96 $330 Level II Noninvasive Physiologic Studies 97 $113 Level I Noninvasive Physiologic Studies 103 $1,576 Miscellaneous Vascular Procedures 105 $2,347 Level I Pacemaker & Similar Procedures 107 $22,916 Level I ICD and Similar Procedures 108 $30,818 Level II ICD and Similar Procedures 152 $1,833 Level I Percutaneous Abdominal and Biliary Procedures 161 $1,227 Level II Cystourethroscopy and other Genitourinary Procedures 174 $8,070 Level IV Laparoscopy 229 $9,628 Level II Endovascular Procedures 267 $190 Level III Diagnostic and Screening Ultrasound 279 $2,560 Level II Angiography and Venography 319 $14,846 Level III Endovascular Procedures 328 $1,407 Level III Skin Procedures

See page i for important information about the uses and limitations if this document. CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CRV-210407-AB FEB2015 A-1 Appendix A 2015 Procedural Payment Guide

APC Reference Table

►pages A1-A2

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view APC APC Category Payment APC Description 423 $4,096 Level II Percutaneous Abdominal and Biliary Procedures 427 $1,289 Level II Tube or Catheter Changes or Repositioning 450 $29 Level I Minor Procedures 621 $843 Level I Vascular Access Procedures 622 $2,236 Level II Vascular Access Procedures 652 $2,288 Insertion of Intraperitoneal and Pleural Catheters 655 $16,407 Level IV Pacemaker and Similar Procedures 668 $827 Level I Angiography and Venography 690 $35 Level I Electronic Analysis of Devices

Category Code (C-Code) Reference Guide 2015 Interventional Cardiology Background: C-Codes are used for hospital outpatient device reporting for Medicare and some private payers. A limited number of C-Codes are eligible for additional pass-through payment from Medicare for the associated device.

C-Codes are VERY important to future reimbursement. Use of all applicable C-Codes on a claim allows identification of device(s) utilized in a procedure and may affect future payment rates.

Coronary Category Codes1 Category Code Description2 C1724 Catheter, transluminal atherectomy, rotational C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

C1753 Catheter, intravascular ultrasound C1757 Catheter, embolectomy/thrombectomy C1769 Guide wire

C1874 Stent, coated/covered, with delivery system C1876 Stent, noncoated/noncovered, with delivery system C1884 Embolization protective system

C1887 Catheter, guiding (may include infusion/perfusion capability) C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

See page i for important information about the uses and limitations if this document. 1 CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. 2 Source: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Complet-list-DeviceCats-OPPS.pdf A-3 CRV-210407-AB FEB2015 Appendix B 2015 Procedural Payment Guide

Peripheral Category Codes1 Category Code Description2 C1724 Catheter, transluminal atherectomy, rotational C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) C1753 Catheter, intravascular ultrasound

C1757 Catheter, thrombectomy, embolectomy C1769 Guide wire C1874 Stent, coated/covered, with delivery system

C1876 Stent, non-coated/non-covered, with delivery system C1880 Vena cava filter C1884 Embolization protective system

C1887 Catheter, guiding (may include infusion/perfusion capability) C2628 Catheter, occlusion

See page i for important information about the uses and limitations if this document. 1 CPT® 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. 2 Source: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Complet-list-DeviceCats-OPPS.pdf A-4 CRV-210407-AB FEB2015 Appendix C 2015 Procedural Payment Guide

ICD-9-CM Code Reference Table ►pages A5-A9

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view ICD-9-CM Code Code Description 00.21 Intravascular imaging of extracranial cerebral vessels 00.22 Intravascular imaging of intrathoracic vessels 00.23 Intravascular imagining of peripheral vessels 00.24 Intravascular imaging of coronary vessels 00.28 Intravascular imaging, other specified vessel(s) 00.29 Intravascular imaging unspecified vessel(s) 00.40 Procedure on single vessel

00.41 Procedure on two vessels

00.42 Procedure on three vessels 00.43 Procedure on four or more vessels 00.44 Procedure on vessel/bifurcation 00.45 Insertion of one vascular stent 00.46 Insertion of two vascular stents 00.47 Insertion of three vascular stents 00.48 Insertion of four or more vascular stents 00.50 Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system 00.51 Implantation of cardiac resynchronization defibrillator, total system 00.52 Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system 00.53 Implantation or replacement of cardiac resynchronization pacemaker, pulse generator only 00.54 Implantation or replacement of cardiac resynchronization defibrillator, pulse generator device only 00.59 Intravascular pressure measurement of coronary arteries 00.61 Percutaneous angioplasty or atherectomy of precerebral, extracranial vessel(s) 00.63 Percutaneous insertion of carotid artery stent(s) 00.66 Percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy 00.69 Intravascular pressure measurement, other specified and unspecified vessels

See page i for important information about the uses and limitations if this document. CRV-210407-AB FEB2015 A-5 Appendix C 2015 Procedural Payment Guide

ICD-9-CM Code Reference Table ►pages A5-A9

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view ICD-9-CM Code Code Description

17.55 Transluminal coronary atherectomy 35.05 Endovascular replacement of aortic valve

35.06 Transapical replacement of aortic valve

35.07 Endovascular replacement of pulmonary valve

35.08 Transapical replacement of pulmonary valve

35.09 Endovascular replacement of unspecified heart valve

35.96 Percutaneous balloon valvuloplasty

35.97 Percutaneous mitral valve repair with implant

36.06 Insertion of non-drug-eluting coronary artery stent(s)

36.07 Insertion of drug-eluting coronary artery stent(s)

36.09 Other removal of coronary obstruction

37.20 Noninvasive programmed electrical stimulation

37.21 Right heart cardiac catheterization

37.22 Left heart cardiac catheterization

37.23 Combined right and left heart cardiac catheterization

37.26 Catheter based invasive electrophysiologic testing

37.27 Cardiac mapping

37.28 Intracardiac echocardiography

37.29 Other diagnostic procedures on heart and pericardium

37.34 Excision or destruction of other lesion or tissue of heart, endovascular approach

37.70 Initial insertion of lead [electrode], not otherwise specified

37.71 Initial insertion of transvenous lead [electrode] into ventricle

See page i for important information about the uses and limitations if this document. CRV-210407-AB FEB2015 A-6 Appendix C 2015 Procedural Payment Guide

ICD-9-CM Code Reference Table ►pages A5-A9

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view ICD-9-CM Code Code Description

37.72 Initial insertion of transvenous leads [electrodes] into atrium and ventricle

37.73 Initial insertion of transvenous lead [electrode] into atrium

37.75 Revision of lead

37.76 Replacement of transvenous atrial and/or ventricular lead(s)

37.77 Removal of lead(s) [electrode] without replacement

37.78 Insertion of temporary transvenous pacemaker system

37.79 Revision or relocation of cardiac device pocket

37.80 Insertion of permanent pacemaker, initial or replacement, type of device not specified

37.81 Initial insertion of single-chamber device, not specified as rate responsive

37.82 Initial insertion of single-chamber device, rate responsive

37.83 Initial insertion of dual-chamber device

37.85 Replacement of any type pacemaker device with single-chamber device, not specified as rate responsive

37.86 Replacement of any type pacemaker device with single-chamber device, rate responsive

37.87 Replacement of any type pacemaker device with dual-chamber device

37.89 Revision or removal of pacemaker device

37.94 Implantation or replacement of automatic cardioverter/defibrillator, total system

37.95 Implantation of automatic cardioverter/defibrillator lead(s) only

37.96 Implantation of automatic cardioverter/defibrillator pulse generator only

37.98 Replacement of automatic cardioverterdefibrillator pulse generator only

38.70 Interruption of the vena cava

38.80 Other surgical occlusion of vessels, unspecified site

38.91 Arterial catheterization

See page i for important information about the uses and limitations if this document. CRV-210407-AB FEB2015 A-7 Appendix C 2015 Procedural Payment Guide

ICD-9-CM Code Reference Table ►pages A5-A9

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view ICD-9-CM Code Code Description

39.10 Intra-abdominal venous shunt

39.49 Other revision of vascular procedure

39.50 Angioplasty or atherectomy of other non-coronary vessel(s)

39.61 Extracorporeal circulation auxiliary to open heart surgery

39.79 Other endovascular procedures on other vessels

39.90 Insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s)

39.99 Other operations on vessels

50.23 Open ablation of liver lesion or tissue

50.24 Percutaneous ablation of liver lesion or tissue

50.25 Laparoscopic ablation of liver lesion or tissue

51.43 Insertion of choledochohepatic tube for decompression

51.87 Endoscopic insertion of stent (tube) into the bile duct

51.94 Revision of anastomosis of biliary tract

51.98 Other percutaneous procedures on biliary tract

51.99 Other operations on biliary tract

55.29 Other diagnostic procedures on kidney

88.45 Arteriography of renal arteries

88.47 Arteriography of other intra-abdominal arteries

88.48 Arteriography of femoral and other lower extremity arteries

88.49 Arteriography of other specified sites

88.50 Angiocardiography, not otherwise specified

88.53 Angiocardiography of left heart structure

See page i for important information about the uses and limitations if this document. CRV-210407-AB FEB2015 A-8 Appendix C 2015 Procedural Payment Guide

ICD-9-CM Code Reference Table ►pages A5-A9

To return to the place last viewed: Alt+left arrow or right click mouse and select previous view ICD-9-CM Code Code Description

89.45 Artificial pacemaker rate check

89.46 Artificial pacemaker artifact wave form check

89.47 Artificial pacemaker electrode impedance check

89.48 Artificial pacemaker voltage or amperage threshold check

89.49 Automatic implantable cardioverter/ defibrillator (AICD) check

89.54 Electrographic monitoring

89.59 Other nonoperative cardiac and vascular measurements

89.68 Monitoring of coronary blood flow

92.28 Injection or instillation of radioisotopes

97.05 Replacement of stent (tube) in biliary or pancreatic duct

97.15 Replacement of wound catheter

See page i for important information about the uses and limitations if this document. CRV-210407-AB FEB2015 A-9

Disclaimer Please note: this coding information may include some codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. Health economics and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is provided for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are 300 Boston Scientific Way not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options. Marlborough, MA 01752-1234 www.bostonscientific.com ® Medical Professionals: CPT Disclaimer 1.800.CARDIAC (227.3422) CPT® Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Patients and Families: Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly 1.866.484.3268 or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. © 2014 Boston Scientific Corporation or its affiliates. All rights reserved. We welcome your feedback. Please send comments to [email protected]

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