Page 1 of 27 See page 4 for important information about the uses and limitations of this document.

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1 CY Medicare Rules Issued for Hospital Outpatient, Ambulatory Surgical Center and Physician Fee Schedule Interventional Cardiology, Peripheral Interventions, Rhythm Management Summary: On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) proposed policies and payment rates for Medicare s Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC). CMS also released the CY proposed rule and payment rates for the Physician Fee Schedule (PFS) on July 8, As is customary, CMS provides the public an opportunity to comment on proposed changes prior to finalizing their decisions in the Rules. The final policy and payment rate are expected around November 1, 2015, and go into effect January 1,. Hospital Outpatient Prospective Payment System CMS estimates that total OPPS payments would decrease by $43 million (0.1 percent), holding case-mix and volume constant. See Table 1 for interventional cardiology, peripheral interventions, and rhythm management related procedures. Important OPPS Policy Changes Affect Cardiovascular Procedures Change to Device Edit Policy (C-Codes) - In CY 2015, CMS finalized a policy whereby any claim assigned to a comprehensive APC required the C-code for the device to be included on the claim for the claim to be processed regardless of whether the comprehensive APC was considered device intensive (i.e. 40% of the cost of the procedure were attributable to the cost of the device). For CY, CMS is proposing to modify this policy so only comprehensive APCs that are found to be device intensive will require the C-code on the claim in order to be processed. Claims submitted with a procedure code requiring a device C-code assigned to an APC would be denied and returned to the provider. Cardiovascular APCs include: pacemakers, ICDs, coronary interventions, and peripheral interventional procedures. CY APC CY 2015 APC CY 2015 APC Title Level I Pacemaker Level II Pacemaker Level III Pacemaker Level IV Pacemaker Level I ICD Level II ICD Level II Endovascular Level III Endovascular Adjustment to OPPS Payments for Discontinued Device Intensive Procedures - CMS has long instructed hospitals regarding the use of modifiers (-73 discontinued outpatient hospital/asc procedure prior to the administration of anesthesia, -74 Discontinued outpatient hospital/asc procedure after the administration of anesthesia, and -52 Reduced services) for when hospitals have to discontinue a procedure and still need to be paid for the services rendered. In this proposed rule, CMS is clarifying how the device costs for device intensive procedures will be handled for those procedures that are discontinued prior to the administration of anesthesia (i.e. -73, potential for -52). CMS is proposing for CY to reduce the APC payment by 100% of the device cost offset amount for those device intensive procedures discontinued prior to the induction of anesthesia. However when anesthesia (including local) is used primarily for interventions, CMS will continue to reimburse at 100% (i.e. -74). Page 1 of 27

2 Multiple Imaging Composite APCs CMS proposes continuing to provide a single payment for multiple imaging services done within the same imaging family on the same day of service. There are three imaging families, Ultrasound, CT/CTA and MRI/MRA. There are five multiple imaging composite APCs, differentiating when CT/CTA and MRI/MRA are done with and without contrast. CMS defines a single imaging session for the with contrast composite APCs as at least one or more imaging procedures from the same imaging family performed with contrast on the same date of service. Hospital Outpatient Quality Reporting (OQR) Program The Hospital OQR Program is a pay for quality data reporting program implemented for outpatient hospital services. Under the program, hospitals must meet administrative, data collection and submission, valuation, and publication requirements or they receive up to a two percentage point reduction in their annual payment update (APU). CMS previously finalized measure set for Hospital OQR Program impacting CY and subsequent years which includes: OP-3 Median time to Transfer to Another Facility for Acute Coronary Intervention (NQF #0290), among other measures. CMS proposes two new measures for the Program: For CY 2018: OP-33 External Beam Radiotherapy (EBRT) for Bone Metastases (NQF #1822) For CY 2019: OP-34 Emergency Department Transfer Communication (EDTC) (NQF #0291) Short Inpatient Hospital Stay (Two-Midnight Rule) - CMS adopted the Two-Midnight Rule for hospital inpatient admissions beginning on October 1, 2013, with the intent to provide greater clarity to hospital and physician stakeholders for when an inpatient admission is reasonable and eligible for payment. As a result of input, CMS is proposing the following: Allow inpatient admission less than two-midnights on a case-by case basis based on the judgment of the admitting physician. Documentation must support the medical necessity of the admission and is subject to review. No change for stays over two-midnight stays. The physician needs to continue to document the medical rationale for the expected length of stay and hospital admission. CMS also proposes to change the Recovery Audit Contractor (RAC) medical review policy including reducing the look back period from 6 months to 3 months when hospitals rebill an inpatient admission denial as an outpatient claim. Transitional Pass-Through (TPT) Payment - CMS is proposing to modify the process for reviewing applications for transitional pass through payment, allowing for more transparency and public comment. Effective April 1, 2015, CMS established a new device TPT category for drug-coated balloons (DCBs), which applies to LUTONIX DCB. The TPT results in incremental payment to hospitals for outpatient services when a DCB is furnished. In addition to the Drug Coated Balloon category, one other cardiovascular TPT category was approved for wireless pulmonary artery pressure sensors (CardioMEMS). Interventional Cardiology Complex Percutaneous Coronary Interventions (PCIs) APC 5193 (DES CTO PCI, DES AMI PCI, Stent with Atherectomy; formerly APC 319) payment proposed to decrease 0.52% to $14,768 o Complexity adjustments, including second main coronary vessel, or additional branch vessel, when in combination with DES or DES bypass graft will group to higher paying APC (See Table 1 for a list of interventional cardiology combination codes) Percutaneous Coronary Interventions (PCIs) APC 5192 (Non-complex stents, BMS CTO, BMS, AMI, atherectomy without stents; formerly APC 229) proposed to increase 0.16% to $9,643 Peripheral Interventions CMS is proposing to assign most PI procedures to newly create APCs. See Table 1 for additional details. Venous and Arterial Mechanical Thrombectomy payments proposed to increase 21.89% to $3,926 AV Fistula Thrombectomy payments proposed to increase 2.10% to $4,634 Iliac PTA, Femoral/Popliteal PTA, and Hemodialysis Access Management (HAM) PTA payments proposed to increase by 2.10% to $4,634 Embolization payments proposed to increase 0.16% to $9,643 Tibial/Peroneal PTA, Iliac Stenting, Femoral/Popliteal Stenting, and Femoral/Popliteal Atherectomy payments proposed to increase by 0.16%% to $9,643 Tibial/Peroneal Stenting, Tibial/Peroneal Atherectomy, and Combined PTA/Stent/Atherectomy payments proposed to decrease by 0.52% to $14,768 Rhythm Management payment rates for ICD system implants would decrease by 0.15% and ICD replacement procedures would decrease by 3.19% Single and dual chamber pacemaker system implants would decrease by 1.04% and pacemaker replacements (dual and single chamber) would increase 3.47% payment rates for ablation procedures performed in conjunction with a comprehensive EP study, which includes most ablation procedures, would increase by 8.37% WATCHMAN Left Atrial Appendage Closure procedure (0281T) is restricted to the inpatient hospital site of service Page 2 of 27

3 Ambulatory Surgical Center: Overall ASC payments rates proposed to increase $186 million (1.4%) over CY 2015 rates. See Table 2 for peripheral interventions, and rhythm management related procedures. Peripheral Interventions All lower extremity bundled PTA, stent and atherectomy procedures are allowed in the ASC; however, less than 1.0% of PI procedures are performed within the ASC Rhythm Management CRT-D/ICD/S-ICD system implants in the ASC are proposed to decrease by 1.02% Dual chamber pacemaker system implant payment rates as well as replacements are proposed to decrease by 1.32% Physician Fee Schedule Table 3 CY 2015 final rates are calculated using the current conversion factor (CF) of $ which remains effective until December 31, 2015, moving to $ beginning January 1,. Overview: Physician Fee Schedule (PFS) - Until this year, annual updates to physician fees followed the Sustainable Growth (SGR) methodology. The SGR methodology threatened annual cuts of 15-30% each year in physician rates since the early 2000s, requiring Congress to pass a doc fix each year to avoid politically unsustainable cuts in physician reimbursement. Earlier this year Congress repealed the SGR method and replaced it with a fixed annual update with a transition to a pay for value method. In the proposed rule, CMS continues to implement these changes to the physician payment methodology. Changes include a 0.5% annual raise through 2019 for Medicare participating providers, then moving to an incentive-based payment system designed to encourage participation in alternative payment models (APM). Merit-Based Incentive Payment System (MIPS) will begin impacting physician payments in Table 3 final rates are calculated with the current conversion factor (CF) of $ which remains effective until December 31, 2015, moving to $ beginning January 1,. Other Policy Changes: Misvalued Services - CMS and other policy analysts believe that there are a number of services for which reimbursement rates may be incorrect relative to the approximate cost of delivering the services. These are commonly referred to as misvalued services. CMS has proposed 118 services as being potentially misvalued and in need of review. By reducing payments for misvalued services, CMS aims to reduce payments by 1.0% in and by 0.5% in 2017 and Cardiovascular procedure codes identified by CMS as being potentially misvalued include: arterial catheter placement, multiple device monitoring codes, and the code for 3-D mapping. CMS now invites comments on the methodology and services identified for inclusion in the calculation. Physician Value-Based - CMS continues to implement the value-based payment modifier for physicians. The program translates quality and cost performance into payment incentives for those who provide high quality, efficient care, while those who underperform may be subject to a downward adjustment. CMS proposes a +/- 4% adjustment for practices with 10 or more providers and +/- 2% for 9 or less impacting CY 2018 payments, based on CY reporting. The value-based modified adjustment will end in 2018, to be replaced by the Merit-based Incentive Payment System (MIPS). Physician Quality Reporting System (PQRS) - CMS continues implementing PQRS, proposing new measures that if finalized, would result in 300 measures in the PQRS measure set for. If an individual eligible provider or group practice does not satisfactorily report these quality measures, a 2% negative payment adjustment would apply in 2018, based on reporting. The PQRS will end in 2018 and starting on January 1, 2019 the Merit-based Incentive Payment System (MIPS) will begin. Global Surgical Package - In 2015, CMS considered addressing the valuation and coding of global surgical packages, which would have revalued 10 and 90-day global CPT codes to 0-day CPT codes. Congress stepped in and stopped the implementation of this 2015 proposal and instead CMS will now develop a process to gather information needed to potentially send surgical services for review under misvalued services. This data has to begin no later than January 1, 2017 and be from a representative sample of surgeons. The collected information must include the number and level of medical visits furnished during the global period and other items and services related to the surgery, as appropriate. Page 3 of 27

4 Interventional Cardiology Coronary Stenting PCIs payment rates are relatively stable o CTO and AMI PCIs proposed to increase by $3 to $710 o Atherectomy with stent payment rate proposed to increase $2 to $709 Stent\PTCA payment rate proposed to increase by $3 to $634 Atherectomy without stent proposed to increase by $3 to $378 Angioplasty payment rate proposed to increase by $2 to $571 Structural Heart-Valves TAVR range of codes stable, proposed to increase an average of 0.3% with a range of $1,428-$2,024 Peripheral Interventions Physician In-Facility reimbursement is flat overall, while reimbursement to physicians for procedures done in their office is proposed to increase 0.90% In-Facility and In-office payments for PTA, Stenting, Atherectomy, and thrombectomy remained stable with none of the payments changing more than 1.50% Rhythm Management Cardiac Rhythm Management device related procedures remain stable with an average increase of 0.05% Electrophysiology procedures remain stable with an average decrease of 0.48% Several device monitoring codes, including the codes for remote monitoring have been identified as potentially misvalued. Also identified as potentially misvalued is the code for 3-D mapping Table Index At the end of the document the following three tables list detailed changes for select Interventional Cardiology (IC), Peripheral Intervention (PI), and Rhythm Management (RM), (reflective of Cardiac Rhythm Management and Electrophysiology) related procedures: Table 1: Hospital Outpatient CY Payment s Table 2: ASC CY Payment s Table 3: Physician CY Fee Schedule Comments or Questions If you have questions or would like additional information please contact: Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) Deb Lorenz Brent Hale Reimbursement Support Line CARDIAC Deb.Lorenz@bsci.com Brent.Hale@bsci.com CRM.Reimbursement@bsci.com Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes on and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Page 4 of 27

5 Table 1: CY Hospital Outpatient Payment s for Select Procedures APC Descriptor CY CY Variance vs. % YoY Change Interventional Cardiology 5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02% * * * Level I Endovascular Procedures (previously APC 83) PTCA (92920) Level II Endovascular Procedures (previously APC 229) DES w/ PTCA (C9600), DES Bypass Graft (C9604), BMS w/ PTCA (92928), BMS Bypass Graft (92937), BMS AMI PCI (92941), BMS CTO PCI (92943), PTCA/Atherectomy (92924) Complexity Adjustments: PTCA + PTCA ( ), PTCA + PTCA add branch ( ) Level III Endovascular Procedures (previously APC 319) DES CTO PCI (C9607), DES AMI PCI (C9606), DES w/atherectomy (C9602), BMS w/atherectomy (92933) Complexity Adjustments: DES + DES (C C9600), DES + DES add branch (C C9601), DES + Coronary Angio / Atherectomy (C ), DES Bypass Graft + DES (C C9600), DES Bypass Graft + DES add branch (C C9601), DES + DES Bypass Graft add branch (C C9605), DES Bypass Graft + DES Bypass Graft (C C9604), DES Bypass Graft + DES Bypass Graft add branch (C C9605), BMS Stent + DES Stent add branch ( C9601), DES + Vasc Stent (C ), DES + Iliac Stent (C ), DES + Insert Pacemaker (C ), DES + Insert Electrode (C ) $4,634 $9,643 $14,768 $4,539 $9,628 $14,846 $95 $15 $ % 0.16% 0.52% BSC currently has no stents FDA approved for CTOs Peripheral Interventions Level 3 Vascular Procedures (previously APC 88) 5183 Arterial Mechanical Thrombectomy (37184), Venous Mechanical Thrombectomy (37187) $3,926 $3,221 $ % Level I Endovascular Procedures (previously APC 83) * 5191 Iliac PTA (37220), FemPop PTA (37224), AV Fistula Thrombectomy $4,634 $4,539 $95 (36870) 2.10% Level II Endovascular Procedures (previously APC 229) TibPer PTA (37228), Iliac Stent (37221), FemPop Atherectomy * 5192 (37225), FemPop Stent (37226), Vasc Embolization ( ) $9,643 $9,628 $ % Complexity Adjustment: AV Fistula Thrombectomy + AV Fistula Thrombectomy ( ) Page 5 of 27

6 Table 1: CY Hospital Outpatient Payment s for Select Procedures APC Descriptor CY CY Variance vs. % YoY Change Level III Endovascular Procedures (previously APC 319) FemPop Stent & Atherectomy (37227), TibPer Atherectomy (37229), TibPer Stent (37230), TibPer Stent & Atherectomy (37231) * 5193 Complexity Adjustments: Iliac Stent + Vasc Stent ( ), FemPop Atherectomy + Iliac Stent ( ), FemPop Atherectomy + Vasc Stent ( ), FemPop Stent + Iliac Stent ( ), FemPop Stent + FemPop Atherectomy ( ), FemPop Stent + FemPop Stent ( ), FemPop Stent + Vasc Stent ( ), FemPop Stent + DES ( C9600), Vasc embo venous + Vasc stent ( ), Vasc embo artery + Iliac stent ( ), Vasc Stent + Vasc Stent ( ), Vasc Stent + Vasc Stent ( ) $14,768 $14,846 $ % * * * 5352 Level 2 Percutaneous Abdominal/Biliary Procedures and Related Procedures (previously APC 423) $4,152 $4,096 $ % Biliary Stent (47556) 2616 Brachytx, non str,yttrium 90 $15,853 $15,583 $ % BSC currently has no stents FDA approved for use in the infrainguinal regions of the lower extremities Rhythm Management 5188 Diagnostic Cardiac Catheterization (previously APC 80) $2,577 $2,576 $1 0.02% Level 1 EP Procedures (previously APC 84) Right ventricular recording (93603) Induction of arrthymia (93618) DFT testing not at implant (93642) Level 2 EP Procedures (previously APC 85) Bundle of HIS recording (93600) Intra atrial recording (93602) Intra atrial pacing (93610) Intraventricular pacing (93612) Comprehensive EP study without induction (93619) Comprehensive EP study with induction (93620) EP follow up study (93624) AV Node Ablation (93650) Level 3 EP Procedures (previously APC 86) SVT ablation with EP study (93653) VT ablation with EP study (93654) $838 $4,750 $15,564 $873 $4,635 $14,362 $35 $115 $1, % 2.49% 8.37% A Fib ablation with EP study (93656) Page 6 of 27

7 Table 1: CY Hospital Outpatient Payment s for Select Procedures APC Descriptor CY CY Variance vs. % YoY Change Level 1 Pacemaker and Similar Procedures (previously APC 0105) Repair single transvenous electrode (33218) Repair 2 transvenous electrodes (33220) Removal of pacemaker generator only (33233) Removal of transvenous pacemaker electrode single (33234) 5221 $3,991 $6,545 Removal of transvenous pacemaker electrode dual (33235) Removal of ICD pulse generator only (33241) Removal of ICD electrode(s) (33244) Removal of S ICD electrode (33272) Repositioning of S ICD electrode (33273) Level 2 Pacemaker and Similar Procedures (previously APC 90) $2, % Insertion of single chamber pacemaker generator only (33212) * 5222 Insertion of single transvenous electrode, pacemaker or ICD (33216) $6,772 $6,545 $ % Insertion of 2 transvenous electrodes, pacemaker or ICD (33217) Single chamber pacemaker change out (33227) Insertion of S ICD electrode (33271) Level 3 Pacemaker and Similar Procedures (Previously APC 89) Insertion of single and dual chamber pacemaker (33206,33207, 33208) Insertion of dual chamber pacemaker generator only (33213) * 5223 Upgrade of single to dual chamber pacemaker (33214) LV lead insertion with attachment to previously placed device (33224) Dual chamber pacemaker change out (33228) Removal of PM generator + LV pacing lead add on ( ) Implant pat active ht record + EP Eval ( ) $9,394 $9,493 $ % Level 4 Pacemaker and Similar Procedures (previously APC 655) Insertion of multiple lead pacemaker generator only (33221) Multiple lead pacemaker change out (33229) * 5224 Insert PM ventricular + LV lead add on ( ), Insert PM atrial & Vent + LV pacing lead add on ( ), Insert PM atrial & vent + Ablate heart dys focus ( ), Insert pacing lead & connect + Insert 1 electrode pm defib ( ), Remv & replc pm gen dual lead + LV pacing lead add on ( ) $16,985 $16,407 $ % Page 7 of 27

8 Table 1: CY Hospital Outpatient Payment s for Select Procedures APC Descriptor CY CY Variance vs. % YoY Change Level 1 ICD and Similar Procedures (ICD/S ICD PG only) (previously APC 107) Insertion of single and dual lead defibrillator pulse generator only (33240,33230) Single or dual lead ICD change out (33262, 33263) Insert PM ventricular + LV lead add on ( ) * 5231 Insert PM atrial & Vent + LV pacing lead add on ( ) $22,186 $22,917 $ % Insert PM atrial & vent + Ablate heart dys focus ( ) * 5232 Insert pacing lead & connect + Insert 1 electrode pm defib ( ) Remv & replc pm gen dual lead + LV pacing lead add on ( ) Level 2 ICD and Similar Procedures (previously APC 108) Insertion of mulitiple lead defibrillator pulse generator only (33231) Insertion of single or dual chamber transvenous ICD system (33249) Multiple lead ICD change out (33264) Insertion of subcutaneous ICD system (33270) CRT D system implant ( ) $30,771 $30,818 $ % * Symbol notes comprehensive APC Common Procedural Terminology (CPT) copyright 2014 American Medical Association. All rights reserved. Page 8 of 27

9 Peripheral Interventions Hemodialysis PTA Table 2: Ambulatory Surgical Center (ASC) ASC CY Payment s for Select Procedures CY CY Payment Payment Transluminal balloon angioplasty, percutaneous; venous Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel Thrombectomy Variance vs. $ $ $ % $1,256 $1,242 $ % $1,328 $1,317 $ % Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra graft thrombolysis) $2,289 $2,220 $ % Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic $2,175 $1,765 $ % guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance $2,175 $1,765 $ % Trach Bronch Stent Bronchosopy (rigid or flexible); with tracheal dilation and placement of tracheal stent $1,979 $1,236 $ % Biliary Stenting Biliary endoscopy, percutaneous via T tube or other tract; with dilation of biliary duct stricture(s) with stent $2,300 $2,244 $ % Insert abdom drain, perm $1,465 $1,254 $ % Exchange drainage catheter $669 $706 ($37) 5.28% Page 9 of 27

10 Table 2: Ambulatory Surgical Center (ASC) ASC CY Payment s for Select Procedures CY CY Payment Payment Variance vs. $ $ $ % Rhythm Management Pacemaker dual chamber system implant $7,749 $7,853 ($104) 1.32% Pacemaker dual chamber pulse generator only $7,749 $7,853 ($104) 1.32% Insertion of ICD / S ICD pulse generator only with existing lead $19,763 $20,292 ($530) 2.61% ICD system implant $26,935 $27,212 ($277) 1.02% Removal with replacement of ICD / S ICD pulse generator only with existing electrode $19,763 $20,292 ($530) 2.61% S-ICD system implant $26,935 $27,212 ($277) 1.02% CRT D System implant (33249 & when performed on the same day) $27,204 $27,212 ($8) 0.03% Page 10 of 27

11 Table 3: Physician Fee Schedule CY Rule Payment s PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. CPT Interventional Cardiology Diagnostic Catheterization Right heart catheterization including measurement(s) of oxygen $151 $0 0.25% $151 $0 0.25% saturation and cardiac output, when performed NA NA NA $805 $7 0.85% Left heart catheterization including intraprocedural injection(s) $263 ($1) 0.33% $263 ($1) 0.33% for left ventriculography; imaging supervision and NA NA NA $907 $5 0.57% Combined right heart cath and left heart catheterization $346 ($1) 0.34% $346 ($1) 0.34% including intraprocedural injection(s) for left ventriculography, NA NA NA $1,167 $6 0.49% Catheter placement in coronary artery(s) for coronary $266 ($0) 0.05% $266 ($0) 0.05% angiography, including intraprocedural injection(s) for coronary NA NA NA $919 $6 0.65% Catheter placement in coronary artery(s) for coronary $307 ($1) 0.21% $307 ($1) 0.21% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,070 $7 0.63% Catheter placement in coronary artery(s) for coronary $341 ($2) 0.46% $341 ($2) 0.46% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,151 $8 0.71% Catheter placement in coronary artery(s) for coronary $382 ($0) 0.08% $382 ($0) 0.08% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,302 $ % Catheter placement in coronary artery(s) for coronary $325 $1 0.27% $325 $1 0.27% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,103 $9 0.79% Catheter placement in coronary artery(s) for coronary $366 $1 0.29% $366 $1 0.29% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,219 $ % Catheter placement in coronary artery(s) for coronary $408 $0 0.05% $408 $0 0.05% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,307 $9 0.68% Catheter placement in coronary artery(s) for coronary $450 ($0) 0.07% $450 ($0) 0.07% angiography, including intraprocedural injection(s) for coronary NA NA NA $1,495 $ % Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) $218 $2 0.82% $218 $2 0.82% $101 $0 0.13% $101 $0 0.13% Physiologic exercise study (eg, bicycle or arm ergometry) $90 $0 0.49% $90 $0 0.49% including assessing hemodynamic measurements before and NA NA NA $281 $2 0.75% Combined right heart catheterization and retrograde left heart cath, for congenital cardiac anomalies $447 ($9) 1.89% $447 ($9) 1.89% Combined right heart catheterization and transseptal left heart cath through intact septum with or w/o retrograde left heart catheterization, for congenital cardiac anomalies $556 ($8) 1.49% $556 ($9) 1.56% Combined right heart catheterization and transseptal left heart cath through existing septal opening, with or w/o retrograde left heart catheterization, for congenital cardiac anomalies $370 ($8) 2.09% $370 ($8) 2.09% Page 11 of 27

12 Diagnostic Cath Injection PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective left ventricular or left arterial angiography (List separately in addition to code for primary procedure) $48 ($0) 1.01% $48 ($0) 1.01% Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure) Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for supravalvular aotography (List separately in addition to code for primary procedure) Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure) $49 $1 1.24% $176 $2 1.11% $55 $1 1.15% $146 $1 0.74% $50 $1 1.22% $158 $1 0.95% Angioplasty without Stent Percutaneous transluminal coronary angioplasty; single major coronary artery or branch $571 $2 0.36% NA NA NA Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) $0 $0 NA $0 $0 NA Atherectomy without Stent Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch Stent with Angioplasty Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch $678 $3 0.38% NA NA NA $0 $0 NA $0 $0 NA $634 $3 0.43% NA NA NA Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) $0 $0 NA $0 $0 NA Page 12 of 27

13 Stent with Atherectomy PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch $709 $2 0.34% NA NA NA Bypass Graft Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel $0 $0 NA $0 $0 NA $634 $3 0.43% NA NA NA Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure) $0 $0 NA $0 $0 NA Acute Myocardial Infarction Chronic Total Occlusion Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel $710 $3 0.39% NA NA NA $710 $3 0.49% NA NA NA Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure) $0 $0 NA $0 $0 NA Page 13 of 27

14 Thrombectomy PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs Percutaneous transluminal coronary thrombectomy mechanical $186 $1 0.49% NA NA NA IVUS Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure) $100 ($2) 1.64% $100 ($2) 1.64% FFR Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure) Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) $80 ($1) 1.29% $80 ($1) 1.29% $100 ($2) 1.64% $100 ($2) 1.64% $80 ($1) 1.29% $80 ($1) 1.29% Valvuloplasty Percutaneous balloon valvuloplasty; aortic valve $1,394 $6 0.41% NA NA NA Percutaneous balloon valvuloplasty; mitral valve $1,437 $6 0.41% NA NA NA Percutaneous balloon valvuloplasty; pulmonary valve $1,135 $2 0.17% NA NA NA Transcatheter Aortic Valve Replacement Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; percutaneous femoral artery approach $1,428 $7 0.49% NA NA NA Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open femoral artery approach Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open axillary artery approach Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; open iliac artery approach Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transaortic approach (e.g., median sternotomy, mediastinotomy) $1,560 $7 0.44% NA NA NA $1,621 ($11) 0.66% NA NA NA $1,699 $8 0.49% NA NA NA $1,871 $9 0.49% NA NA NA Page 14 of 27

15 33366 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) $2,024 $9 0.44% NA NA NA Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (list separately in addition to code for primary procedure) Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure) Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure) $658 $5 0.77% NA NA NA $788 $3 0.44% NA NA NA $1,042 $7 0.70% NA NA NA Page 15 of 27

16 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. CPT Peripheral Interventions Non Coronary Angioplasty Transluminal balloon angioplasty, percutaneous; $351 ($0) 0.13% $1,606 $ % brachiocephalic trunk or branches, each vessel Transluminal balloon angioplasty, percutaneous; venous $284 ($0) 0.15% $1,473 $ % Radiological S&I (Non Cor Angioplasty) Transluminal balloon angioplasty, peripheral artery other than $27 $1 4.62% $27 $1 4.62% cervical carotid, renal or other visceral artery, iliac or lower NA NA NA $144 $4 2.82% Transluminal balloon angioplasty, each additional peripheral $18 $0 2.54% $18 $0 2.54% artery other than cervical carotid, renal or other visceral artery, NA NA NA $90 $3 3.40% Transluminal balloon angioplasty, renal/visceral artery, $66 $0 0.49% $66 $0 0.49% radiological S&I NA NA NA $175 $2 0.91% Transluminal balloon angioplasty, renal/visceral, each additional $18 $0 2.50% $18 $0 2.50% artery, S&I (List separately in addition to code for primary NA NA NA $89 ($0) 0.32% Transluminal balloon angioplasty, venous (eg, subclavian $27 $1 4.62% $27 $1 4.62% stenosis), radiological S&I NA NA NA $142 $3 2.32% Iliac Artery Revascularization Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty $439 ($0) 0.00% $3,262 $ % Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) $541 $1 0.16% $4,808 $ % $199 $1 0.31% $916 $9 1.05% $227 $0 0.01% $2,674 $ % Femoral/Popliteal Artery Revascularization Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within same vessel, when performed $484 ($0) 0.03% $3,957 $ % $657 $2 0.38% $11,377 $ % Page 16 of 27

17 37226 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s),unilateral;with transluminal stent placement(s), includes angioplasty within the same vessel, when performed $569 $0 0.05% $9,352 $ % Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed $789 $2 0.26% $15,365 $ % BSC currently has no stents FDA approved for use in the infrainguinal regions of the lower extremities Tibeal / Peroneal Artery Revascularization Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with transluminal angioplasty $591 $0 0.06% $5,623 $ % Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed $765 $1 0.16% $11,208 $ % Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed $754 $0 0.06% $8,572 $ % Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed $819 $0 0.05% $13,793 $ % Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code fore primary procedure) Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code fore primary procedure) $215 $1 0.32% $1,253 $9 0.69% $350 $1 0.28% $1,512 $7 0.44% BSC currently has no stents FDA approved for use in the infrainguinal regions of the lower extremities Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code fore primary procedure) $301 ($1) 0.23% $4,006 $ % Page 17 of 27

18 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs Revascularization, endovascular, open or percutaneous, tibeal\peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code fore primary procedure) $428 $ % $4,216 ($45) 1.05% Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure) $478 ($1) 0.26% $4,246 $4 0.10% $226 ($2) 0.94% $2,539 ($4) 0.16% Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure) $331 ($5) 1.44% $4,328 $ % $158 ($1) 0.64% $2,096 $ % Catheter Access Introduction of needle or intracatheter; extremity artery $109 $1 0.83% $448 $1 0.17% Access av dial grft for eval $195 ($0) 0.06% $863 $9 1.08% Access av dial grft for proc $52 ($0) 0.21% $270 $2 0.76% Introduction of needle or intracatheter, aortic, translumbar $130 ($0) 0.34% $509 $2 0.42% Introduction of catheter, aorta $161 ($0) 0.18% $643 $4 0.60% Catheter Placement Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family $247 ($1) 0.24% $1,160 $9 0.74% $291 $4 1.24% $1,240 $ % Page 18 of 27

19 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a $347 $6 1.65% $2,073 $ % vascular family Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate) Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family $56 $1 1.80% $199 $ % $265 $0 0.08% $1,415 $ % $282 ($1) 0.28% $918 $5 0.53% $334 ($1) 0.16% $1,626 $ % Carotid Artery Stenting Vena Cava Filters Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; without distal embolic protection Insertion of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed. $52 $0 0.49% $158 $1 0.95% $1,059 ($88) 7.64% NA NA NA $0 $0 NA $0 $0 NA $251 ($0) 0.08% $2,718 $ % Repositioning of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed. $386 ($7) 1.81% $1,598 ($121) 7.03% Retrieval (removal) of inferior vena cava filter, endovascular approach including vascular access, vessel selection and radiological supervision and interpretation (including ultrasound) when performed. $385 ($1) 0.26% $1,651 $ % Page 19 of 27

20 Thrombectomy PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs. Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra graft thrombolysis) $315 ($0) 0.08% $1,892 $ % Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel $485 ($2) 0.33% $2,344 $ % Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure $178 $1 0.49% $746 $ % Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure) Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance $263 $0 0.08% $1,423 $ % $429 ($0) 0.10% $2,124 $ % Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy $309 $0 0.02% $1,835 $ % Thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision Thrombectomy, with or without catheter; radial or ulnar artery, by arm incision Thrombectomy, with or without catheter; femoral\popliteal, aortoiliac artery, by leg incision $641 $2 0.26% NA NA NA $640 $4 0.60% NA NA NA $1,097 $0 0.03% NA NA NA Page 20 of 27

21 PFS rates compared to 2015 rates effective July 1, 2015 Variance Variance vs vs Thrombectomy, with or without catheter; axillary and subclavian vein, by arm incision $654 $6 0.99% NA NA NA Thrombolysis Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow up catheter contrast injection, position change, or exchange, when performed $420 ($2) 0.37% NA NA NA $370 $0 0.10% NA NA NA $260 ($1) 0.20% NA NA NA Non Coronary IVUS 3725A 3725B Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method Intravascular ultrasound (non coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (non coronary vessel) during diagnostic evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure) Radiological S&I (Non Cor IVUS) Intravascular ultrasound (peripheral vessel) radiological supervision and interpretation; initial vessel $143 ($0) 0.27% NA NA NA $94 ($19) 16.81% $1,440 NA NA $75 ($10) 11.77% $221 NA NA $21 $0 0.49% $21 $0 0.49% each additional non coronary vessel (List separately in addition to code for primary procedure) $20 ($0) 1.27% $20 ($0) 1.27% Angiograms Angiography, extremity, unilateral, radiological supervision and $58 $2 4.41% $58 $2 4.41% interpretation NA NA NA $167 $4 2.71% Page 21 of 27