Reimbursement and Coding

Coding Guides and C-Codes

Electrophysiology Coding Guide

Medicare coding and payment guide for EP services, including catheter ablation.
 

Electrophysiology (EP) FAQ Guide

Abbott offers the Electrophysiology FAQ as an overview outlining the 2022 EP Medicare Physician Reimbursement related to the bundling of Supraventricular tachycardia (SVT) ablation, Ventricular tachycardia (VT) ablation, and Pulmonary Vein Isolation (PVI) for atrial fibrillation (AF) ablation procedures. This resource will provide guidance on the 2022 impacts to physician coding descriptors, the impacts of these changes on physician reimbursement rates, and the drivers behind these changes.
 

Intracardiac echocardiography (ICE) Add-On Coding Reference Guide

This resource provides coding and reimbursement information as it relates to the 2022 ICE (Intracardiac echocardiography) add-on coding update and its impacts on Electrophysiology, Heart Failure, Cardiac Rhythm Management, and Structural Heart procedure codes.
 

HCPCS Device Category C-codes

Current list of reimbursement Healthcare Procedural Coding System (HCPCS) Device Category C-codes

Printable form for easy CPT^‡ coding reference
 

Frequently Used CPT Codes for Catheter Ablation and Related Procedures

Printable form for easy CPT coding reference
 

Tool Kit Instructions United Healthcare Prior Authorization for Catheter Ablation for Atrial Fibrillation

This toolkit provides suggested instruction and summary of the United Healthcare guidelines for facilitating their prior authorization requirements. It is not an endorsed resource of United Healthcare as providers are highly encouraged to review the United Healthcare policy and requirements for prior authorization and medical guidelines.
 

Prior Authorization Checklist for Electrophysiologist(s)

Download this checklist for submitting prior authorization requests for your patient. The checklist includes a summary of the information used to process prior authorization requests for Atrial Fibrillation.
 

Letter of Prior Authorization and Medical Necessity for Atrial Fibrillation

Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for Atrial Fibrillation. Physicians should customize the letter based on the patient's medical history and diagnosis and to be consistent with any specific prior authorization requirements from the health plan.
 

CMS Inpatient Reimbursement Prospectus

This guide provides a summary of the Medicare Hospital Inpatient Prospective Payment System (IPPS). It includes information on the Readmission Reductions Program, Value Based Purchasing, and Hospital Inpatient Reimbursement Rates for select cardiovascular DRGs. For more detailed information, please refer to the FY IPPS Final Rule on the CMS website.
 

CMS Outpatient Reimbursement Prospectus

This guide provides a summary of the Medicare Hospital Outpatient Prospective Payment System (OPPS) Update. It includes updates to the Comprehensive APC Policy, Site Neutral Payments, Device Intensive Procedures, the Transitional Pass-Through Payment Policy, and Hospital Outpatient Reimbursement Rates for select cardiovascular APCs. For more detailed information, please refer to the CY OPPS Final Rule on the CMS website.

Webinars

2022 Medicare Payment and Coding Update Focused on Electrophysiology Procedures

The webcast addresses coding and reimbursement supporting Electrophysiology procedures. We will provide an overview of the 2022 Medicare reimbursement for EP ablations, EP studies, and other add-on services. There are new coding updates for AF and SVT ablation procedures effective for CY2022 that will be comprehensively reviewed.

Centers for Medicare and Medicaid (CMS)

Cardiac Catheterization Performed in Other Than a Hospital Setting

Provides Medicare guidance on coverage when the procedure is performed in a location other than a hospital
 

CMS Physician Fee Schedule

This guide includes Medicare Physician Payment Rates for cardiovascular procedures. For more detailed information, please refer to the CY Physician Fee Schedule Final Rule on the CMS website.
 

Medicare Local Coverage Determinations (LCDs)
 

Medicare Learning Network (MLN) Matters Articles

Focusing on coverage, billing, and payment rules for specific provider types, these articles explain national Medicare policy in an easy-to-understand format.
 

National Correct Coding Initiatives Edits

Developed by CMS, the initiative promotes correct coding methodologies to control improper coding leading to inappropriate payment.