Coding and coverage resources Cardiovascular reimbursement

Reimbursement resources

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules, and regulations. As a result, Medtronic does not represent or guarantee that this information is complete, accurate, or applicable to any particular patient or third-party payer or guarantees payment.

The provider has the responsibility to determine medical necessity and to submit appropriate documentation, codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies and any applicable laws or regulations that may apply.

These documents provide assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (e.g., instructions for use, operator’s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

C-code listings

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.

Below is a downloadable PDF document listing Vascular product names and their associated C-codes.

Cardiovascular reimbursement overview

Blood pressure management with renal denervation

Cardiac surgery resources

Left atrial appendage exclusion

Extracorporeal membrane oxygenation

Blood management

Cardiothoracic procedures