Shockwave Medical has announced that as part of the calendar year 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) has created four new codes for intravascular lithotripsy (IVL) procedures performed in the tibial and peroneal, or below-the-knee (BTK), arteries in the hospital outpatient setting. These codes will be effective Jan. 1, 2021.
In creating the four new Healthcare Common Procedure Coding System (HCPCS) codes (C9772–C9775), CMS noted that “resources associated with tibial and peroneal IVL procedures are higher than iliac, femoral and popliteal procedures.” Previously, in July 2020, CMS issued four codes (C9764–C9767) to describe IVL performed in all lower-extremity arteries.
As part of the 2021 OPPS final rule, these initial codes have now been redefined to report IVL procedures performed in lower-extremity arteries, except tibial and peroneal. Starting in January 2021, there will now be four codes that pertain to below-the-knee IVL procedures and four that pertain to above-the-knee IVL procedures.
In addition, CMS assigned the new HCPCS codes to Ambulatory Payment Classifications (APCs) that determine hospital outpatient payment. These APC assignments are consistent with similar interventional procedures performed in the BTK arteries.
Also effective Jan. 1, 2021, CMS added IVL procedures to the list of services covered in an Ambulatory Surgical Center (ASC) setting.
“We appreciate CMS’s swift action in adding these new codes as they acknowledge the differentiation between above-the-knee and below-the-knee procedures and that complex BTK interventions involving IVL require more resources,” said Doug Godshall, president and CEO of Shockwave Medical.
“Importantly,” he continued, “we believe these new HCPCS codes, which now increase payment for IVL procedures performed BTK, will further facilitate access to IVL technology for Medicare patients, while also allowing data collection specific to IVL procedures performed BTK.”
