Reimbursement and Coding

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

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.

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

Printable form for easy CPT‡ coding reference

Printable form for easy CPT coding reference

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.

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.

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.

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.

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.

The webcast addresses coding and reimbursement supporting Electrophysiology procedures. We will provide an overview of the 2023 Medicare reimbursement for EP ablations, EP studies, and other add-on services.

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

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.

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

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