Reimbursement and Coding

CardioMEMS HF System Coding Guide

This Medicare coding and payment guide offers information about reimbursement for pulmonary artery pressure long-term hemodynamic monitoring.

CardioMEMS HF System FAQ Guide

Physician Non-Facility Remote Monitoring Rates by Location

This document provides a Medicare coding and payment overview for remote monitoring by location.

HCPCS Device Category C-codes

This document delivers a current list of reimbursement Healthcare Procedural Coding System (HCPCS) Device Category C-codes

Frequently Used CPT Codes for Cardiac Device Monitoring Services

This printable form offers an easy CPT coding reference.

Prior Authorization and Appeals

Abbott offers the Prior Authorization and Appeals templates for use by providers when seeking prior authorization or appealing denials of coverage. The objective of these resources is to provide assistance in submitting individual coverage consideration for appropriately indicated patients who may benefit from implantation of a pulmonary sensor device for remote hemodynamic monitoring of heart failure. Download the templates using the links below to customize and provide medical justification for consideration of this procedure.

Letter of Prior Authorization and Medical Necessity

Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for CardioMEMS implant. 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.

Letter of Appeal

Download a sample letter template that provides suggestions to assist in writing a Letter of Appeal of a denial of coverage for CardioMEMS implant procedures. Physicians should customize the letter based on the patient's medical history and diagnosis, and to be consistent with any specific appeal requirements from the health plan.

Webinars

2022 Medicare Payment and Coding Update Focused on the CardioMEMS HF System

This webcast addresses the 2022 Medicare Payment Updates for the Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), the Physician Fee Schedule (PFS), and coding and coverage for procedures supporting the CardioMEMS HF System implant and remote monitoring.

Centers for Medicare and Medicaid Services (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 Prospectus

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.

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.

Medicare Local Coverage Determinations (LCDs)

In the absence of a national coverage policy, an item or service may be covered at a local basis. Check here for a list of CMS policies that provide Medicare beneficiaries coverage in certain locations across the country.

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.

HE&R Disclaimer

This document and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.