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Heart Failure

Find reimbursement resources, including coding guides, links to Medicare Coverage Determinations, on-demand webinars, and frequently asked questions for pulmonry artery pressure monitoring.

 

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Pulmonary Pressure Monitoring

Important Medicare Local Coverage Determination (LCD) Update

As of July 1st, 2020, Novitas Solutions, Inc. (NOVITAS) and First Coast Service Options, Inc. (FCSO) retired their local non-coverage policies (LCD L36419 and LCD L33777) for CardioMEMS. Novitas is the Medicare Administrative Contractor (MAC) that administers the Medicare claims for DE, MD, NJ, PA, DC, AR, CO, LA, MS, NM, OK and TX. FCSO is the MAC for FL, Puerto Rico, and the Virgin Islands.

For dates of service on and after July 1st, 2020, providers can provide pulmonary artery pressure sensor implant (CPT 33289) and remote monitoring services (CPT 93264) for appropriately indicated Medicare patients based on reasonable and medically necessary guidelines similar to the other Medicare contractors. This means that Novitas and FCSO will implicitly cover wireless pulmonary artery sensor implants and remote monitoring based on medical appropriateness and the FDA approved indication, and the claims processing edits for denying the aforementioned procedure codes will be removed. Providers should continue to document medical necessity of CardioMEMS for their patients.

If you need further assistance, connect with our Patient Therapy Access Team by phone or email: +1-800-727-7846

Coding Guides and Resources

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

Common CPT Code Modifiers

This printable form offers an easy CPT coding reference.

Frequently Used CPT Codes for Cardiac Device Monitoring Services

This printable form offers an easy CPT coding reference.

Webinars

2020 Medicare Payment and Coding Update focused on the CardioMEMS Heart Failure System

This webcast addresses the 2020 Medicare Outpatient Prospective Payment System (OPPS), Physician Fee Schedule (PFS) payment and new CPT 1 codes for the CardioMEMS 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.

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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.

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