Davol NOTE: ICD-9 Listings Are for Reference Only. ICD-10PCS Coding

Davol 2016 Medicare Final Rule National Average Payments

NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.

Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient Hospital

Hernia Repair 49500 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible $421 $373 -11.4% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 49501 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated $619 $605 -2.3% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.0-53.17 350 - Inguinal and Femoral Hernia Procedures with MCC $14,467 $13,575 -6.2% 49505 Repair initial inguinal hernia, age 5 years or older; reducible $531 $540 1.7% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.9 351 - Inguinal and Femoral Hernia Procedures with CC $8,226 $7,667 -6.8% 49507 Repair initial inguinal hernia, age 5 years or older; incarcerated or 352 - Inguinal and Femoral Hernia Procedures without strangulated $598 $608 1.7% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% CC/MCC $5,448 $5,306 -2.6% 49520 Repair recurrent inguinal hernia, any age; reducible $645 $656 1.7% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 49560 Repair initial incisional or ventral hernia; reducible 353 - Hernia Procedures Except Inguinal and Femoral $753 $765 1.6% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.41, 53.49 with MCC $17,055 $15,835 -7.2% 49561 Repair initial incisional or ventral hernia; incarcerated or 354 - Hernia Procedures Except Inguinal and Femoral strangulated $950 $966 1.7% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.51, 53.61 with CC $9,921 $9,042 -8.9% 49565 Repair recurrent incisional or ventral hernia; reducible 355 - Hernia Procedures Except Inguinal and Femoral $785 $797 1.5% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% without CC/MCC $7,344 $6,719 -8.5% 49566 Repair recurrent incisional or ventral hernia; incarcerated or strangulated $958 $975 1.8% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% N/A 49568 Implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) $274 $278 1.5% N/A N/A Inclusive to main procedure DRG 49580 Repair umbilical hernia, younger than age 5 years; reducible $340 $345 1.5% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 49582 Repair umbilical hernia, younger than age 5 years; incarcerated or 353 - Hernia Procedures Except Inguinal and Femoral strangulated $493 $502 1.8% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.41, 53.49 with MCC $17,055 $15,835 -7.2% 49585 Repair umbilical hernia, age 5 years or older; reducible 354 - Hernia Procedures Except Inguinal and Femoral $454 $461 1.5% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% 53.51, 53.61 with CC $9,921 $9,042 -8.9% 49587 Repair umbilical hernia, age 5 years or older; incarcerated or 355 - Hernia Procedures Except Inguinal and Femoral strangulated $486 $493 1.4% $2,674 $2,613 -2.3% $1,466 $1,461 -0.3% without CC/MCC $7,344 $6,719 -8.5%

11008 Removal of mesh in abdominal wall for infection Inpatient Inpatient Inpatient Inpatient $281 $287 2.1% Only Only Only Only N/A

Component Separation 15734 Muscle, myocutaneous, or fasciocutaneous flap; trunk (Note: Report 15734 twice if procedure is bilateral) $1,521 $1,552 2.0% $1,345 $1,370 1.9% $2,301 $2,137 -7.1% $1,262 $1,195 -5.3% 83.82 Secondary to primary hernia DRG

Parastomal Hernia Repair 44346 Revision of colostomy; with repair of paracolostomy hernia Inpatient Inpatient Inpatient Inpatient (separate procedure) $1,212 $1,231 1.6% Only Only Only Only 46.42 347 - Anal and Stomal Procedures with MCC $15,383 $13,290 -13.6% 348 - Anal and Stomal Procedures with CC $8,109 $7,871 -2.9% 349 - Anal and Stomal Procedures without CC/MCC $5,325 $5,034 -5.5% Hiatal Hernia Repair 43332 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other Inpatient Inpatient Inpatient Inpatient prosthesis $1,189 $1,209 1.7% Only Only Only Only 53.80 43333 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other Inpatient Inpatient Inpatient Inpatient 326 - Stomach, Esophageal and Duodenal Procedures prosthesis $1,296 $1,319 1.8% Only Only Only Only 53.80 with MCC $31,584 $29,588 -6.3% 43334 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other Inpatient Inpatient Inpatient Inpatient 327 - Stomach, Esophageal and Duodenal Procedures prosthesis $1,288 $1,312 1.9% Only Only Only Only 53.80 with CC $15,563 $14,345 -7.8% 43335 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other Inpatient Inpatient Inpatient Inpatient 328 - Stomach, Esophageal and Duodenal Procedures prosthesis $1,384 $1,408 1.7% Only Only Only Only 53.80 without CC/MCC $8,768 $8,234 -6.1% 43336 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of Inpatient Inpatient Inpatient Inpatient mesh or other prosthesis $1,561 $1,578 1.1% Only Only Only Only 53.80 43337 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of Inpatient Inpatient Inpatient Inpatient mesh or other prosthesis $1,678 $1,702 1.4% Only Only Only Only 53.80

1 of 4 Davol 2016 Medicare Final Rule National Average Payments

NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.

Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient Hospital

39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; 53.71, 53.72, chronic Inpatient Inpatient Inpatient Inpatient 53.75, 53.83, 326 - Stomach, Esophageal and Duodenal Procedures $889 $900 1.2% Only Only Only Only 53.84 with MCC $31,584 $29,588 -6.3% 327 - Stomach, Esophageal and Duodenal Procedures with CC $15,563 $14,345 -7.8% 328 - Stomach, Esophageal and Duodenal Procedures without CC/MCC $8,768 $8,234 -6.1% Laparoscopic Procedures

43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, 326 - Stomach, Esophageal and Duodenal Procedures Toupet procedures) $1,107 $1,125 1.6% $5,477 $6,861 25.3% N/A N/A 44.67 with MCC $31,584 $29,588 -6.3% 327 - Stomach, Esophageal and Duodenal Procedures with CC $15,563 $14,345 -7.8% 328 - Stomach, Esophageal and Duodenal Procedures without CC/MCC $8,768 $8,234 -6.1%

49650 Laparoscopy, surgical; repair initial inguinal hernia $437 $444 1.6% $3,778 $4,001 5.9% $2,072 $2,011 -2.9% 350 - Inguinal and Femoral Hernia Procedures with MCC $14,467 $13,575 -6.2% 17.11, 17.12, 17.13, 17.21, 351 - Inguinal and Femoral Hernia Procedures with CC $8,226 $7,667 -6.8% 17.23, 17.24 352 - Inguinal and Femoral Hernia Procedures without CC/MCC $5,448 $5,306 -2.6%

49651 Laparoscopy, surgical; repair recurrent inguinal hernia $568 $576 1.4% $3,778 $4,001 5.9% $2,072 $2,011 -2.9% 350 - Inguinal and Femoral Hernia Procedures with MCC $14,467 $13,575 -6.2% 17.11, 17.12, 17.13, 17.21, 351 - Inguinal and Femoral Hernia Procedures with CC $8,226 $7,667 -6.8% 17.23, 17.24 352 - Inguinal and Femoral Hernia Procedures without CC/MCC $5,448 $5,306 -2.6%

49652 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); 53.42, 53.43, reducible $760 $772 1.6% $5,477 $4,001 -26.9% $3,003 $2,011 -33.0% 53.63 49653 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); 53.42, 53.43, incarcerated or strangulated $948 $963 1.6% $5,477 $4,001 -26.9% $3,003 $2,011 -33.0% 53.63 49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh 53.42, 53.43, 353 - Hernia Procedures Except Inguinal and Femoral insertion, when performed); reducible $864 $877 1.5% $5,477 $6,861 25.3% $3,003 $3,278 9.2% 53.63 with MCC $17,055 $15,835 -7.2% 49655 Laparoscopy, surgical, repair, incisional hernia (includes mesh 354 - Hernia Procedures Except Inguinal and Femoral insertion, when performed); incarcerated or strangulated $1,055 $1,071 1.5% $5,477 $6,861 25.3% $3,003 $3,278 9.2% 53.62 with CC $9,921 $9,042 -8.9% 49656 Laparoscopy, surgical, repair, recurrent incisional hernia (includes 355 - Hernia Procedures Except Inguinal and Femoral mesh insertion, when performed); reducible $939 $954 1.6% $5,477 $6,861 25.3% $3,003 $3,278 9.2% 53.62 without CC/MCC $7,344 $6,719 -8.5% 49657 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated $1,350 $1,371 1.6% $5,477 $6,861 25.3% $3,003 $3,278 9.2% 53.62

2 of 4 Davol 2016 Medicare Final Rule National Average Payments

NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.

Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient Hospital

$77 $76 -1.3% $24 $24 0.0% $146 $226 54.8% N/A N/A 86.22 901 - Wound Debridements for Injuries with MCC $23,420 $21,393 -8.7% 97598 Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters $25 $25 0.0% $12 $11 -8.3% packaged packaged N/A N/A 86.28 902 - Wound Debridements for Injuries with CC $10,225 $9,925 -2.9%

903 - Wound Debridements for Injuries without CC/MCC $6,616 $6,370 -3.7% Breast Reconstruction +15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary procedure) $218 $223 2.3% packaged packaged packaged packaged

19324 Mammaplasty, augmentation, without prosthetic implant 85.50, 85.53, $499 $505 1.2% $4,149 $3,647 -12.1% $2,275 $2,039 -10.4% 85.54

584- Breast biopsy, local excision and other breast procedures with CC/MCC $10,371 $9,126 -12.0% 585- Breast biopsy, local excision and other breast procedures without CC/MCC $8,066 $8,251 2.3% 19325 Mammaplasty, augmentation, with prosthetic implant $653 $665 1.8% $7,330 $7,558 3.1% $4,055 $3,137 -22.6% 85.53, 85.54 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1%

19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction $1,022 $1,044 2.2% $4,150 $3,647 -12.1% $2,275 $2,039 -10.4% 85.33, 85.34 582-Mastectomy for malignancy with CC/MCC $7,627 $7,265 -4.7% 583- Mastectomy for malignancy without CC/MCC $6,412 $6,442 0.5% 584- Breast biopsy, local excision and other breast procedures with CC/MCC $10,371 $9,126 -12.0% 585- Breast biopsy, local excision and other breast procedures without CC/MCC $8,066 $8,251 2.3% 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1% 19342 Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction $939 $959 2.1% $7,461 $7,558 1.3% $4,055 $3,137 -22.6% 85.33, 85.34

19350 Nipple/areola reconstruction 584- Breast biopsy, local excision and other breast $835 $852 2.0% $686 $700 2.0% $2,167 $2,188 1.0% $1,188 $1,223 2.9% 85.87 procedures with CC/MCC $10,371 $9,126 -12.0% 585- Breast biopsy, local excision and other breast procedures without CC/MCC $8,066 $8,251 2.3% 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1% 19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion $1,533 $1,565 2.1% $7,461 $7,558 1.3% $4,055 $3,137 -22.6% 85.95

3 of 4 Davol 2016 Medicare Final Rule National Average Payments

NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.

Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient Hospital

Reference: ICD-9 Procedure Code (See In-office (Free Standing below for Procedure CPT Code Description Center) In Hospital (Professional Fee) APC Payment ASC Payment ICD-10 link) MS-DRG Description Nat'l Avg. Payment 2015 2016 % Change 2015 2016 % Change 2015 2016 % Change 2015 2016 % Change 2015 2016 % Change 19361 Breast reconstruction with latissimus dorsi flap, without prosthetic Inpatient Inpatient Inpatient Inpatient implant $1,605 $1,637 2.0% Only Only Only Only 85.42, 85.71 582-Mastectomy for malignancy with CC/MCC $7,627 $7,265 -4.7% 19364 Breast reconstruction with free flap Inpatient Inpatient Inpatient Inpatient 85.73, 85.74, $2,813 $2,871 2.1% Only Only Only Only 85.75, 85.76 583- Mastectomy for malignancy without CC/MCC $6,412 $6,442 0.5% 19366 Breast reconstruction with other technique 85.55, 85.70, 584- Breast biopsy, local excision and other breast $1,435 $1,459 1.7% $3,012 $3,647 21.1% $1,651 $2,039 23.5% 85.79, 85.85 procedures with CC/MCC $10,371 $9,126 -12.0% 19367 Breast reconstruction with transverse rectus abdominus myocutaneous flap [TRAM], single pedicle, including closure of Inpatient Inpatient Inpatient Inpatient 585- Breast biopsy, local excision and other breast donor site $1,827 $1,861 1.9% Only Only Only Only 85.72 procedures without CC/MCC $8,066 $8,251 2.3% 19368 Breast reconstruction with TRAM, single pedicle, including of closure of donor site; with microvascular anastomosis Inpatient Inpatient Inpatient Inpatient (supercharged) $2,247 $2,295 2.1% Only Only Only Only 85.72 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 19369 Breast reconstruction with TRAM, double pedicle, including closure Inpatient Inpatient Inpatient Inpatient of donor site $2,085 $2,124 1.9% Only Only Only Only 85.72 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1%

19370 Open periprosthetic capsulectomy, breast 584- Breast biopsy, local excision and other breast $698 $714 2.3% $3,012 $3,647 21.1% $1,651 $2,039 23.5% 85.00, 85.21 procedures with CC/MCC $10,371 $9,126 -12.0% 585- Breast biopsy, local excision and other breast procedures without CC/MCC $8,066 $8,251 2.3% 19371 Periprosthetic capsulectomy, breast $799 $815 2.0% $3,012 $2,188 -27.4% $1,651 $1,223 -25.9% 85.00, 85.21 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 19380 Revision of reconstructed breast $788 $804 2.0% $4,149 $3,647 -12.1% $2,275 $2,039 -10.4% 85.93 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1%

19396 Preparation of moulage for custom breast implant $296 $286 -3.4% $149 $146 -2.0% $3,012 $2,188 -27.4% $1,651 $1,223 -25.9% 99.99 Secondary to primary DRG

11970 Replacement of tissue expander with permanent prosthesis 85.53, 85.54, 584- Breast biopsy, local excision and other breast $619 $633 2.3% $3,762 $4,969 32.1% $2,063 $2,486 20.5% 85.96, 86.05 procedures with CC/MCC $10,371 $9,126 -12.0% 585- Breast biopsy, local excision and other breast procedures without CC/MCC $8,066 $8,251 2.3% 907- Other OR procedures for injuries with MCC $22,214 $20,688 -6.9% 908- Other OR procedures for injuries with CC $11,482 $10,816 -5.8% 909- Other OR procedures for injuries with CC/MCC $7,365 $7,060 -4.1% ICD-10 Weblink: Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets will replace ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at

http://www.icd10data.com/Convert

American Medical Association's "Physician's Current Procedural Terminology CPT 2014", www.ama-assn.org DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 412, 413, 416, and 419, [CMS-1633-FC; CMS-1607-F2], RIN 0938-AS42; RIN 0938-AS11; Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review

DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 411, 414, 425, and 495, [CMS-1631-FC], RIN 0938-AS40; Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016

DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services,42 CFR Part 412, [CMS-1632-F and IFC], RIN-0938-AS41; Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals

C. R. Bard, Inc. does not guarantee that use of any of the codes provided will ensure coverage or payment at any particular level. Medicare may implement policies differently in various sections of the country. Physicians and hospitals should confirm with a particular payor or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular procedure or combination of procedures. Reimbursement for a product or procedure can be different depending upon the setting in which the product is used. Coverage and payment policies also change over time, so that information provided here may at some point need to be revised.

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