Coding, Coverage, and Reimbursement Resources Cardiac Rhythm and Heart Failure

Overview

As a service to our customers, we provide resources to assist with coding, coverage, and reimbursement for our therapies. You will find some of these tools available for download on this site, or you may contact us for more information.


Mechanical Circulatory Support: Ventricular Assist Devices (VADs)

The Centers for Medicare and Medicaid Services (CMS) and commercial payers provide coverage for implantation of ventricular assist devices (VADs) for specific indications. A VAD treats patients suffering from advanced heart failure. It is surgically attached to one or both intact ventricles and is used to assist or augment the ability of the damaged or weakened heart to pump blood. The HeartWare™ HVAD™ System features a small centrifugal blood pump that draws blood from the left ventricle and propels it through an outflow graft connected to the patient’s ascending aorta.

pdf Hospital and Physician Reimbursement Guide (.pdf)

A comprehensive, 48-page reimbursement overview including common VAD and insurance terminology, coverage considerations, frequently asked reimbursement questions, and DME payments by state. (May 2017)

2.2MB

pdf Coding and Payment Bulletin  (.pdf)

A handy, 4-page reference that provides appropriate CPT, ICD-10-PCS coding and associated 2017 national Medicare reimbursement rates. (May 2017)

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MICRA™ LEADLESS (TRANSCATHETER) PACEMAKER

The Centers for Medicare & Medicaid Services (CMS) recently approved coverage for the Medtronic Micra™ Transcatheter Pacing System through Coverage with Evidence Development (CED). The Micra is a pacemaker, delivered percutaneously via a minimally invasive approach, directly into the right ventricle without the use of leads. Leadless pacemakers, also known as intracardiac or transcatheter pacemakers, are the first and only pacemakers in which the components are combined into a single device implanted directly within the heart, without any subcutaneous pocket or tunneling.

pdf MICRA Transcatheter Pacing System Coverage Coding & Payment Bulletin (.pdf)

This bulletin provides information related to CMS Approval of the Medtronic Micra Transcatheter Pacing System Post-Approval Study (PAS) & Prospective Longitudinal Study, the Micra CED. It includes coverage indications and study requirements, coding criteria and payment information for Medicare. (August 9, 2017)

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mp4 MICRA TPS Reimbursement Overview for Customers (.mp4)

This presentation and accompanying audio was delivered to customers in March – June 2017.  This presentation provides an overview of the Micra TPS, Leadless pacemaker cover decision, and coding and reimbursement. The slides and audio can be accessed at the Micra TPS Reimbursement Overview link above. (June 15, 2017)

214.7MB

pdf MICRA TPS Frequently Asked Questions (FAQs) (.pdf)

This bulletin provides answers to many FAQs pertaining to Micra: Coverage, Access, Billing and Contact Information. (May 31, 2017)

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pdf MICRA TPS U.S. Private Payer Prior Authorization (.pdf)

This bulletin is intended to provide clear, factual and balanced information that may be pertinent to the process by which physicians and patients make an appeal to a U.S. private payer for coverage for Micra TPS when used in accordance with FDA-approved labeling. (May 18, 2017)

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pdf MICRA TPS Coverage with Evidence Development (CED) Study (.pdf)

This document is intended to provide clear, factual, and balanced information that may facilitate detailed understanding of the Micra TPS CED Study when used in accordance with FDA-approved labeling. (May 31, 2017)

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MEDICARE PAYMENT INITIATIVES

pdf MIPS and Advanced APM tracks within the Medicare’s QPP (.pdf)

Medicare’s physician focused Quality Payment Program (QPP) is part of CMS’ broader initiatives to tie Medicare fee-for-service payments to quality and value. The QPP includes both the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs) established by the MACRA legislation.

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pdf Medicare’s Bundled Payment Initiatives (.pdf)

Medicare’s bundled payment programs, including both the Bundled Payments for Care Improvement (BPCI) models and Episode Payment Models (EPMs), are part of CMS’s broader initiatives to promote quality, value of health care services to beneficiaries, through coordination of services among providers. Through bundled payments, providers are accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries for an episode of care across several providers.

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CRHF CODING AND REIMBURSEMENT RESOURCES

Hospital

pdf 2017 Hospital Coding Reference Guide for CRHF Procedures (.pdf)

This booklet provides a live link for ICD-10 inpatient procedure coding options, hospital outpatient procedure codes, and Medicare C-APC/APC assignments for select Cardiac Rhythm and Heart Failure (CRHF) procedures.

171KB

pdf 2017 Hospital Outpatient Procedures (.pdf)

This form contains a listing of CPT or HCPCS codes for Outpatient services performed in the hospital. Services listed include the implant, replacement/removal and follow-up of pacemakers, ICDs, ILRs and CRT devices. 2 pages.

119KB

PHYSICIAN

pdf 2017 Physician Reference Guide for CRHF Procedures (.pdf)

This booklet includes physician procedure codes for select Cardiac Rhythm and Heart Failure (CRHF) procedures.

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pdf 2017 Physician CRHF Procedures for Services Provided in the Hospital (.pdf)

This form contains a listing of CPT codes for Physician services typically performed in the hospital setting.

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