CRHF REIMBURSEMENT & HEALTH POLICY Pacemaker Therapy COMMONLY BILLED CODES AND ASSOCIATED 2018 MEDICARE RATES This document reflects commonly billed codes for Pacemaker Therapy and their associated National reimbursement rates. This is not an all-inclusive list. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third-party payers as to the correct form of billing or the amount that will be paid to providers of service. Physician/Hospital Outpatient Coding is based on specific procedures that are performed, and multiple procedure codes may be reported. This may result in multiple procedure payment reduction for Physician payments. Hospital outpatient reimbursement is subject to various packaging rules, including Comprehensive APCs (C-APCs). Under C-APCs, only one payment is made for all procedures and supplies provided during the outpatient episode of care. Physician and hospital outpatient rates are effective through the 2018 calendar year National National APC or C-APC Rate 3 CPT 1 APC Code or C-APC Generator Insertion Procedures 33206 Insertion of new or replacement of permanent pacemaker with $472 5223 $9,748 transvenous electrode(s); atrial 33207 Insertion of new or replacement of permanent pacemaker with $503 5223 $9,748 transvenous electrode(s); ventricular 33208 Insertion of new or replacement of permanent pacemaker with $545 5223 $9,748 transvenous electrode(s); atrial and ventricular 0387T Transcatheter insertion or replacement of permanent leadless Contractor 5194 $16,020 pacemaker, ventricular Lead Insertion Procedures 33216 Insertion of a single transvenous electrode, permanent pacemaker or $387 5222 $7,371 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or $380 5222 $7,371 Generator Insertion Procedures with Existing Leads 33212 Insertion of pacemaker pulse generator only; with existing single lead $335 5222 $7,371 33213 Insertion of pacemaker pulse generator only; with existing dual leads $350 5223 $9,748 33221 Insertion of pacemaker pulse generator only; with existing multiple leads $376 5224 $17,586 Page 1 of 6 January 2018
CPT 1 Code Medicare C-APC or APC National APC or C-APC Rates 3 Upgrade Single Chamber to Dual Chamber 33214 Upgrade of implanted, conversion of single chamber system to dual chamber system (includes removal of previously placed $500 5223 $9,748 pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Insertion or Replacement of Temporary Pacing Lead 33210 Insertion or replacement of temporary transvenous single chamber $172 5222 $7,371 cardiac electrode or pacemaker catheter (separate procedure) 33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) $177 5222 $7,371 Generator Only Change Out Procedures 33227 Removal of permanent pacemaker pulse generator with replacement of $353 5222 $7,371 pacemaker pulse generator; single lead system 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system $369 5223 $9,748 Removal Procedure 0388T Transcatheter removal of permanent leadless pacemaker, ventricular Contractor 5183 $2,493 Removal Generator Procedure 33233 Removal of permanent pacemaker pulse generator only $240 5222 $7,371 Removal Lead Procedures 33234 Removal of transvenous pacemaker electrode(s); single lead system, $507 5221 $2,868 atrial or ventricular 33235 Removal of transvenous pacemaker electrode(s); dual lead system $667 5221 $2,868 Reposition or Repair Leads 33215 Repositioning of previously implanted transvenous pacemaker or $325 5183 $2,493 (right atrial or right ventricular) electrode 33218 Repair of single transvenous electrode, permanent pacemaker or $405 5221 $2,868 33220 Repair of 2 transvenous electrodes for permanent pacemaker or $409 5221 $2,868 Pocket Relocation 33222 Relocation of skin pocket for pacemaker $352 5054 $1,568 Epicardial Lead Procedures 33202 Insertion of epicardial electrode(s); open incision (eg, thoracotomy, $809 N/A Inpatient Only median sternotomy, subxiphoid approach) 33203 Insertion of epicardial electrode(s); endoscopic approach (eg, $843 N/A Inpatient Only thoracoscopy, pericardioscopy) 33236 Removal of permanent epicardial pacemaker and electrodes by $815 N/A Inpatient Only thoracotomy; single lead system, atrial or ventricular 33237 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system $875 N/A Inpatient Only In-person Interrogation and Programming Evaluations Pacemakers 93279 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead $50 5741 $38 $33 (26) $17 (TC) Page 2 of 6 January 2018
CPT 1 Code In-person Interrogation and Programming Evaluations (continued) 93280 Programming device evaluation (in person) with iterative adjustment of the permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system 93281 Programming device evaluation (in person) with iterative adjustment of the permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead 93288 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead 0389T 0391T Programming device evaluation (in person) with iterative adjustment of the permanent programmed values with analysis, review and report, leadless Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless Remote Interrogation Evaluations 93294 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead with interim analysis, review(s) and report(s) by a physician or other qualified health care professional 93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead or system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Medicare C-APC or APC $59 5741 $38 $39 (26) $20 (TC) $64 5741 $38 $44 (26) $21 (TC) $39 5741 $38 $22 (26) $17 (TC) Contractor Contractor 5741 $38 5741 $38 Medicare C-APC or APC Rates 3 $31 N/A Physician Only $27 5741 $38 Key 26 Professional TC Technical Page 3 of 6 January 2018
Inpatient Coding ICD-10-PCS Inpatient hospital ICD-10-PCS codes do not include system implantation codes. Each specific device-related procedure must be individually coded. The following ICD-10-PCS codes describe commonly performed pacemaker procedures. This is not an all-inclusive list. These codes are only used by hospitals for reporting inpatient services. ICD-10-PCS Generator Insertion 0JH606Z or 0JH605Z or 0JH604Z Insertion Pacemaker Lead 02HK3NZ Insertion 02H63JZ and/or 02HK3JZ Lead Removal 02PA3MZ Generator Removal 0JPT0PZ 0JWT0PZ Non-Invasive Programmed Stimulation Insertion of pacemaker, dual chamber into chest subcutaneous tissue and fascia, open approach Insertion of pacemaker, single chamber rate responsive into chest subcutaneous tissue and fascia, open approach Insertion of pacemaker, single chamber into chest subcutaneous tissue and fascia, open approach Insertion of Intracardiac Pacemaker into Right Ventricle, Percutaneous Approach Insertion of pacemaker lead into right atrium, percutaneous approach Insertion of pacemaker lead into right ventricle, percutaneous approach Removal of cardiac lead from heart, percutaneous approach Removal of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach Revision of cardiac rhythm related device in trunk subcutaneous tissue and fascia, open approach 4B02XSZ Measurement of cardiac pacemaker, external approach Inpatient Reimbursement Medicare reimbursement for inpatient hospital services is based on a classification system known as Medicare Severity- Diagnosis Related Groups (MS-DRGs). MS-DRG assignment is determined by patient diagnoses and procedures. Only one MS-DRG is assigned per hospital admission, and one payment is made for all procedures and supplies related to that inpatient stay. MS-DRG assignment may be affected when one or more secondary diagnoses that are included in the Major Complication or Comorbidity (MCC), or Complication or Comorbidity (CC) lists which are maintained by CMS. MS-DRG 228 Other cardiothoracic procedures w/mcc $39,753 229 Other cardiothoracic procedures w/o MCC $27,627 242 Permanent Cardiac Pacemaker Implant w/mcc $22,331 243 Permanent Cardiac Pacemaker Implant w/cc $15,722 244 Permanent Cardiac Pacemaker Implant w/o CC/MCC $12,894 258 Cardiac Pacemaker device replacement w/ MCC $18,570 259 Cardiac Pacemaker device replacement w/o MCC $12,577 Final FY 2018 National Medicare Rates 4 Page 4 of 6 January 2018
MS-DRG Cont d 260 Cardiac Pacemaker Revision except device replacement w/mcc $21,620 261 Cardiac Pacemaker Revision except device replacement w/cc $11,680 262 Cardiac Pacemaker Revision except device replacement w/o CC/MCC $9,950 MCC Major Complication or Comorbidity CC Complication or Comorbidity Final FY 2018 National Medicare Rate 4 References 1 CPT codes and descriptions only are copyright 2017 American Medical Association. All rights reserved. No fee schedules are included in CPT. The American Medical Association assumes no liability for data contained or not contained herein. 2 Final Medicare PFS for CY 2018 released on Wednesday November 15, 2017. This document and associated file can be found at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/ PhysicianFeeSched/PFS-Federal-Regulation-Notices.html. CMS may make adjustments to any or all of the data inputs from time to time. 3 Hospital Outpatient regulation and data files for CY 2018 are available at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/ HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html. Actual payments may vary based on various hospital-specific factors not reflected in the source data and CMS may make adjustments to any or all of the data inputs from time to time. 4 Final corrected Hospital Inpatient Medicare regulation and data files for FY 2018 are available at: https://www.cms.gov/medicare/medicare-fee-for- Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page. html. Medtronic and the Medtronic logo are trademarks of Medtronic. Third party brands are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. Medtronic 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Toll-free in USA: 800.633.8766 Worldwide: +1.763.514.4000 medtronic.com UC201703150b EN 2018 Medtronic. Minneapolis, MN. All Rights Reserved. Printed in USA. 01/2018 Page 5 of 6 January 2018