CARDIOVASCULAR
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Here is the key information you need to help ensure patient access to cardiovascular care that requires advanced medical technology. You’ll find:

  • Current coding, coverage and payment information pertaining to the full range of our medical technologies.
  • Visit Medicare Reimbursement Guides for summaries of recent Inpatient Hospital, Outpatient Hospital, and Physician Fee Schedule policy changes.
  • Visit C-Codes for a listing of CMS medical device C-Codes.

Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies.

For a description of Abbott products related to interventional cardiology and peripheral intervention, please see Products

REIMBURSEMENT QUESTIONS?

Contact the Abbott Vascular Product Reimbursement Hotline at 800 354 9997 or Questions@AskAbbottVascular.com.

ABBOTT PRODUCT C-CODES

Effective January 1, 2005, hospitals are required to use Medicare C-Codes when billing for devices used in the outpatient setting. Requiring the use of C-Codes to identify devices used in conjunction with procedures paid for under OPPS will greatly improve the quality of claims data Medicare uses to establish APC payments in the future. The full list of C-codes can be found on the CMS website.

Medicare has established outpatient coding edits dictating which specific C-Codes should be billed with which CPT procedure code. The list of coding edits is not all-inclusive and Medicare will add edits to the list on a quarterly basis in conjunction with the quarterly Outpatient Coding Editor (OCE) release. Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies.

The following is an abbreviated list of C-Codes, relevant to Abbott’s vascular products.

For a list of Abbott’s vascular products and their associated C-Codes, please click here: C-Code listing by product

For a description of Abbott interventional cardiology products, please click here: Products

 


REFERENCES

*Carotid artery stent implantation is an inpatient only procedure for Medicare coverage. The C-Code is used primarily for internal charging to capture the cost of the embolic protection system.
References: HCPCS Release and Code Sets, 2012 Alpha-Numeric HCPCS Downloads accessed on October 1, 2012 from http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp

MEDICARE REIMBURSEMENT GUIDES

Abbott provides summaries of Medicare hospital and physician policy and reimbursement information.  Please click the links below to download the Medicare Reimbursement Guides.


2019 Inpatient Prospective Payment System (IPPS)

(Effective October 1, 2018 to September 30, 2019)
This guide provides a summary of the Medicare Hospital Inpatient Prospective Payment System (IPPS) Update for Fiscal Year 2019. It includes information on the Readmission Reductions Program, Value Based Purchasing, and 2019 Hospital Inpatient Reimbursement Rates for select cardiovascular DRGs.

For more detailed information, please refer to the FY 2019 IPPS Final Rule on the CMS website.

2019 Outpatient Prospective Payment System (OPPS)

(Effective January 1, 2019 to December 31, 2019)
This guide provides a summary of the Medicare Hospital Outpatient Prospective Payment System (OPPS) Update for Calendar Year 2019. It includes updates to the Comprehensive APC Policy, Site Neutral Payments, Device Intensive Procedures, the Transitional Pass-Through Payment Policy, and 2019 Hospital Outpatient Reimbursement Rates for select cardiovascular APCs.

For more detailed information, please refer to the CY 2019 OPPS Final Rule on the CMS website.

2019 Physician Fee Reimbursement Guide

(Effective January 1, 2019 to December 31, 2019)
This guide includes Medicare Physician Payment Rates for peripheral vascular procedures for Calendar Year 2019.

For more detailed information, please refer to the CY 2019 Physician Fee Schedule Final Rule on the CMS website.


MORE CODING RESOURCES

Common CPT Code Modifiers

Printable form for easy CPT coding reference

HCPCS Device Category C-Codes

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


Providers should consult with their payers regarding appropriate documentation, medical necessity, and coding information consistent with individual payer requirements and policies.

CAROTID ARTERY STENTING

Here you’ll find the information you need related to coding, coverage and reimbursement of carotid artery stenting. Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies. If you have any questions related to the former ICD-9 or current ICD-10 coding for procedures involving Abbott devices, please contact the Reimbursement Hotline at 800 354 9997 or Questions@AskAbbottVascular.com.


CAROTID ARTERY STENTING COVERAGE

Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies.

Medicare (CMS) Coverage

CMS coverage of carotid artery stenting (CAS) began in July 2001 when coverage of CAS was limited to patients enrolled in an IDE trial. Since that time, CMS has published multiple related coverage policies for carotid artery stenting. Policies cover CAS in an IDE investigational trial setting, in a post-approval trial setting, in a post-approval extension trial setting, and for a subset of FDA-approved indications, there is coverage outside of trials. Please view the CMS national coverage determination  for additional information.

Please note: Effective December 9, 2009 Medicare clarified coverage for carotid artery stenting requiring the use of an FDA-approved or cleared embolic protection device. Medicare clarified if deployment of the embolic protection device is not technically possible, and not performed, then the procedure is not covered by Medicare.1

In September 2014, CMS granted approval for Percutaneous Transluminal Angioplasty (PTA) to cover carotid artery stenting through the CREST-2 trial and the CREST-2 Registry.  Please view the CMS national coverage determination for additional information.

CREST-2

(Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial)

CREST-2, sponsored by the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH), is intended to evaluate the best approach for managing asymptomatic patients with high-grade carotid atherosclerotic stenosis. This prospective multi-center randomized controlled trial started enrollment in 2014 and is expected to complete final data collection for primary outcome measure in 2020. CREST-2 site selection and credentialing is managed by a multi-disciplinary committee.  Please visit the NIH StrokeNet web site or the CREST-2 Trial web site for additional information.

CREST-2 Registry (C2R)

The objective of CREST-2 Registry is to promote the rapid initiation and completion of patient enrollment in the CREST-2 trial. Accreditation for Cardiovascular Excellence (ACE) was selected by CMS to accredit C2R clinical sites

National Cardiovascular Data Registry (NCDR) Peripheral Vascular Intervention (PVI) Registry  and Society for Vascular Surgery’s Vascular Quality Initiative (VQI)  are the selected registries to administer C2R data collection. Each C2R participating operator/site is required to have membership for either the NCDR-PVI Registry or the SVS-VQI Registry.

Commercial Coverage Policies / Other Third-Party Payers

Because commercial coverage varies regionally, Abbott recommends that providers verify insurance coverage prior to performing procedures.

 

1Center for Medicare and Medicaid Services (CMS), Pub 100-3 Medicare National Coverage Determinations, Transmittal 115, March 5, 2010. http://www.cms.gov/transmittals/downloads/R115NCD.pdf

References:
Centers for Medicare and Medicaid Services at www.cms.gov


CMS APPROVED FACILITIES FOR CAROTID ARTERY STENTING

Effective March 2005, the Centers for Medicare and Medicaid Services (CMS) expanded coverage of carotid artery stenting (CAS) to patients who were not enrolled in medical device trials (IDE or FDA-required post-approval). With the coverage decision, CMS stated that all facilities who planned to develop a carotid stenting program and treat patients outside of studies would have to meet additional requirements. For detailed information about CMS' coverage policy of carotid stenting procedures, please visit:

http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=201&ver=9

These requirements are summarized below:

  • All facilities shall submit an affidavit attesting to meeting specific minimum standards or attesting that they have participated in an FDA-approved carotid stenting trial (IDE or FDA required post-approval study)
  • Facilities will collect data on all carotid stenting procedures
  • Facilities will have a clear credentialing program for interventionalists performing carotid stenting

Click here to view the list of CMS Approved Carotid Stenting Facilities at the CMS website.
 


CAROTID STENTING PRIOR AUTHORIZATION TOOL KIT

Abbott offers this Carotid Stenting Prior Authorization Tool Kit for use by physicians and their offices when seeking prior authorization or submitting claims to plans requiring such pre-procedure approvals. This comprehensive tool kit includes information to assist your office in submitting prior authorization requests to private payers to confirm coverage for patients who may benefit from a carotid artery stent (CAS) procedure. Download the guide and the accompanying forms using the links below.

Abbott recommends seeking prior authorization for all cases except those covered by traditional (fee for service) Medicare. Please note, prior authorization is not required for fee for service Medicare patients.

Providers should consult with their payers regarding appropriate documentation, medical necessity, and coding information consistent with individual payer requirements and policies.

Should your office need any additional reimbursement support materials or have any questions pertaining to the prior authorization process for CAS patients, please contact the Abbott Reimbursement Hotline at 1-800-354-9997 or questions@askabbottvascular.com

Click to download Tool Kit Instructions
Download this guide for submitting prior authorization requests for your patients to private payers. It includes instructions on how to use this tool kit and the associated forms and provides a checklist of the key steps necessary to request authorization.

Click to download the FDA CAS Approval Letter
Download a copy of the FDA approval letter for the RX Acculink Carotid Stent System. This letter may be required as part of the submission for CAS authorization.

Click to download the Sample STANDARD RISK Letter of Medical Necessity
Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for the Acculink Carotid Artery Stent System with Accunet Embolic Protection for patients with carotid artery disease at standard surgical risk. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific payer requirements.

Click to download the Sample HIGH RISK Letter of Medical Necessity
Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for the Acculink Carotid Artery Stent System with Accunet Embolic Protection for patients with carotid artery disease at high surgical risk. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific payer requirements.

CORONARY INTERVENTIONS

Here you’ll find the information you need related to coding, coverage and reimbursement for coronary interventions. Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies. If you have any questions related to the former ICD-9 or current ICD-10 coding for procedures involving Abbott devices, please contact the Reimbursement Hotline at 800 354 9997 or Questions@AskAbbottVascular.com.


Vessel Closure

The following code has been assigned to occlusive devices by CMS: G0269

G0269 is defined as: placement of an occlusive device in either a venous or arterial access site, post-surgical or interventional procedure. Code G0269 should be used on Medicare claims to record the placement of the vasoseal and for other payers as directed.

 

REFERENCES

Centers for Medicare and Medicaid Services at www.cms.gov
ICD-10 Procedure Coding System (ICD-10-PCS) 2017 Tables and Index, Optum 360.
CPT® is a trademark of the American Medical Association.
Current Procedure Terminology (CPT®) is copyright 2014. American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
American Medical Association. CPT® 2014. Professional Edition. Chicago, IL.


CORONARY INTERVENTIONS COVERAGE

Local Medicare Administrative Contractors (MACs) as well as other third party payers have their own coverage policies for coronary interventions and devices. You should contact your local Medicare Contractor and third party payers for information on their specific coverage policies for interventional cardiology. There is currently no national Medicare coverage decision for coronary interventions. Most local Medicare Contractors, Fiscal Intermediaries and/or Carriers have posted their Local Coverage Determinations (LCD) on interventional cardiology on their websites.

You can find a list of Medicare Administrative Contractors, Fiscal Intermediaries and Carriers at the CMS webpage

 

PERIPHERAL INTERVENTIONS

Here you’ll find the information you need related to coding, coverage and reimbursement for peripheral interventions. Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies. If you have any questions related to the former ICD-9 or current ICD-10 coding for procedures involving Abbott devices, please contact the Reimbursement Hotline at 800 354 9997 or Questions@AskAbbottVascular.com.


The following code has been assigned to occlusive devices by CMS: G0269

G0269 is defined as: placement of an occlusive device in either a venous or arterial access site, post-surgical or interventional procedure. Code G0269 should be used on Medicare claims to record the placement of the vasoseal and for other payers as directed.

 

References:
Centers for Medicare and Medicaid Services at www.cms.gov
ICD-10 Procedure Coding System (ICD-10-PCS) 2017 Tables and Index, Optum 360.
CPT® Copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


PERIPHERAL INTERVENTIONS COVERAGE

Providers should consult with their payers regarding appropriate documentation, medical necessity and coding information consistent with individual payer requirements and policies.

Medicare Coverage

Medicare coverage of Percutaneous Transluminal Angioplasty (PTA) falls under a National Coverage Determination (NCD). Please click here to link to the NCD: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=201&ver=9. Coverage for peripheral vessel stenting may vary by Medicare Contractor. Abbott recommends that providers verify Medicare coverage of peripheral procedures prior to date of service.

Commercial Coverage

Commercial Coverage of peripheral interventions may vary.

For reimbursement purposes, Abbott Vascular recommends that providers verify insurance coverage prior to performing a procedure.

 

Disclaimer: The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. It is the responsibility of the hospital or physician to determine appropriate coding for a particular patient and/or procedure. Any claim should be coded appropriately and supported with adequate documentation in the medical record. A determination of medical necessity is a prerequisite that Abbott assumes will have been made prior to assigning codes or requesting payments. Any codes provided are examples of codes that specify some procedures or which are otherwise supported by prevailing coding practices. They are not necessarily correct coding for any specific procedure using Abbott products.

Hospitals and physicians should consult with appropriate payers, including Medicare Administrative Contractors, for specific information on proper coding, billing, and payment levels for healthcare procedures. Abbott makes no express or implied warranty or guarantee that (i) the list of codes and narratives in this document is complete or error-free, (ii) the use of this information will prevent difference of opinions or disputes with payers, (iii) these codes will be covered [or (iv) the provider will receive the reimbursement amounts set forth herein]. Reimbursement policies can vary considerably from one region to another and may change over time.

The FDA-approved/cleared labeling for all products may not be consistent with all uses described herein. This web page is in no way intended to promote the off-label use of medical devices. The content is not intended to instruct hospitals and/or physicians on how to use medical devices or bill for healthcare procedures. 

Last Updated: December 2018

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