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CMS Increases Hospital Outpatient Payment for Peripheral Intravascular Lithotripsy
Above the Knee Peripheral IVL APC Assignments Increased in CY 2022 Final Hospital Outpatient Rule
SANTA CLARA, Calif., Nov. 03, 2021 — Shockwave Medical, Inc., a pioneer in the development and commercialization of Intravascular Lithotripsy (IVL) to treat complex calcified peripheral and coronary artery disease, announced today that as part of the calendar year 2022 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) has reassigned the payment for peripheral IVL procedures performed on above the knee (ATK) arteries in the hospital outpatient setting. The resulting payment increases will become effective January 1, 2022.
As part of the 2022 OPPS final rule, CMS has announced new Ambulatory Payment Classification (APC) assignments for three Healthcare Common Procedure Coding System (HCPCS) codes that describe peripheral IVL procedures performed in lower extremity arteries in the outpatient hospital setting. The three HCPCS codes affected describe procedures in iliac, femoral and popliteal arteries when IVL is performed by itself or adjunctively with drug coated balloons (DCB), stents or atherectomy. The new APC assignments will increase the payments hospitals receive for these procedures. The relevant codes are as follows:
| HCPCS |
CY2021 APC Assignment |
Final CY2021 Payment |
CY2022 APC Assignment |
Final CY2022 Payment |
|||
| Code | Long Descriptor | ||||||
| C9764 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed | 5192 | $4,957 | 5193 | $10,258 | ||
| C9765 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed | 5193 | $10,043 | 5194 | $16,402 | ||
| C9766 | Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed | 5193 | $10,043 | 5194 | $16,402 | ||
The APC assignments for the remaining peripheral IVL HCPCS codes (C9767, C9772, C9773, C9774, C9775) remain unchanged.
“We appreciate CMS’s collaborative relationship and their swift action in reassigning payment levels for IVL performed above the knee, as the data acknowledge the resources associated with performing IVL in these patients. Importantly, we believe the APC reassignment of these HCPCS codes and subsequent increased payment for IVL procedures performed ATK will further facilitate access to IVL technology for Medicare patients,” said Doug Godshall, President and Chief Executive Officer of Shockwave Medical. “We would like to acknowledge CMS for making an exception to this year’s standard ratesetting process by considering calendar year 2020 data when determining appropriate payment levels for the new peripheral IVL code set. We are also grateful for the support that came from CMS’ Hospital Outpatient Physician Advisory panel and medical societies during the public comment period.”
About Shockwave Medical, Inc.
Shockwave is focused on developing and commercializing products intended to transform the way calcified cardiovascular disease is treated. Shockwave aims to establish a new standard of care for the interventional treatment of atherosclerotic cardiovascular disease through differentiated and proprietary local delivery of sonic pressure waves for the treatment of calcified plaque, which the company refers to as Intravascular Lithotripsy (IVL). IVL is a minimally invasive, easy-to-use and safe way to significantly improve patient outcomes. To view an animation of the IVL procedure and for more information, visit www.shockwavemedical.com.
