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.


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. (March 15, 2017)

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pdf MICRA Customer Presentation  (.pdf)

Three customer presentations were provided (two on Friday March 17, 2017 and one on Monday March 20, 2017). The slides that were shown and discussed are available by accessing the MICRA Customer Presentation link above. (March 27, 2017)

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

This bulletin provides answers to many FAQs pertaining to Micra: Coverage, Access, Billing and Contact Information. (March 27, 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.

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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.

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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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