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Coding, Coverage, and Reimbursement Resources

Cardiac Rhythm and Heart Failure

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Hospital Inpatient and Outpatient Resources

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Coding

Coding Resource

Medtronic provides medical coding resources related to Cardiac Rhythm and Heart Failure (CRHF) products and procedures to help facilitate appropriate medical billing and coding practices for service provided. 

CMS C-code Requirements

Effective January 1, 2005, CMS began requiring hospitals to bill appropriate C-codes for all device-dependent Ambulatory Payment Classifications (APCs). If a hospital outpatient bill includes a device-related CPT/HCPCS II procedure code but the C code for the associated device is not present, the claim is edited and returned to the hospital. Furthermore, if a C code is billed without the appropriate procedure code, the claim will be returned.

For most C-codes, the hospital does not receive additional reimbursement for devices. The C-codes are required because CMS is collecting charge data for these devices for use in setting future reimbursement rates.

Coding Reference Guides

Reveal® Reimbursement Guide and Tip Card

Reveal® Reimbursement Guide (PDF, 173 KB)
This booklet presents reimbursement information for Reveal XT and Reveal DX Insertable Cardiac Monitors. 4 pages.

Reveal XT™ Tip Card (PDF, 230 KB)
This tip card contains indications, guidelines, clinical evidence, and coding overview for diagnosing suspected arrhythmias. 2 pages.

2016 Catheter Ablation Reimbursement Guide effective January 2016

2016 Catheter Ablation Reimbursement Guide effective January 2016 (PDF, 1.3 MB)
This guide provides coding information related to Catheter Ablation procedures for inpatient and outpatient hospitals and physicians. 8 pages.

QR Modifier Is Replaced With Q0 (Zero) Modifier - Implemented July 6, 2010

CMS Manual System: Pub 100-20 One-Time Notification (PDF, 195 KB)
The QR modifier which was used to identify primary prevention patients indicated for an ICD has been replaced with a new modifier, Q0 (zero). The Q0 modifier should be used on both physician and hospital outpatient claims.This document provides full details on the modification.

Reimbursement Guide for ICD Implants

Reimbursement Guide for ICD Implants (PDF, 715 KB)
This guide has been developed to assist you in seeking coverage and payment for ICD and CRT-D therapies. It also provides hospital and physician coding information and some answers to frequently asked questions (FAQs).

Payment