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RS (ICD)CARDIACRESYNCHRONIZATIONTHERAPY (CRT)IMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)CARDIAC DEVICEMONITORINGABBOTT CODING GUIDECARDIAC PACEMAKERSIMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)CARDIAC RESYNCHRONIZATION THERAPY (CRT-P & D)IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)CARDIAC DEVICE MONITORINGEffective October 1, 2020ReferencesPages 1 of 54
RS (ICD)CARDIACRESYNCHRONIZATIONTHERAPY (CRT)IMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)CARDIAC DEVICEMONITORINGCARDIAC PACEMAKERSIMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)AND IMPLANTABLE/INSERTABLE CARDIAC MONITORS (ICM)Effective October 1, 2020IntroductionReimbursement HotlineThe Cardiac Pacemakers, Implantable Cardioverter Defibrillators (ICD), CardiacResynchronization Therapy and Implantable/Insertable Cardiac Monitors (ICM)Coding Guide is intended to provide reimbursement educational information tiedto use of these products when used consistently with the products' labeling. Thisguide includes information regarding coverage, coding and reimbursement, aswell as general information regarding appealing denied claims and supportingdocumentation.In addition, Abbott offers a reimbursement hotline, which provides live codingand reimbursement information from dedicated reimbursement specialists.Coding and reimbursement support is available from 8 a.m. to 5 p.m. central time,Monday through Friday at (855) 569-6430 or hce@abbott.com. This guide andall supporting documents are available at html. Coding and reimbursement assistance is provided subject tothe disclaimers set forth in this guide.Remote Monitoring Reimbursement ChangesDisclaimerEffective January 1, 2020, the code for the technical component of remotemonitoring for Implantable Cardiovascular Physiologic Monitoring Systems andImplantable/Insertable Cardiac Monitors (ICMs), CPT Code 93299, will be deleted.The Centers for Medicare & Medicaid Services (CMS) created a new G-code,G2066, to report this service. G2066 can be reported by physicians and outpatienthospitals. G2066 will continue to be carrier-priced, as 93299 was, and thedescription of the code will be the same. See pages 49 and 53 for more information.This document and the information contained herein is for general informationpurposes only and is not intended, and does not constitute, legal, reimbursement,business, clinical, or other advice. Furthermore, it is not intended to and does notconstitute a representation or guarantee of reimbursement, payment, or charge,or that reimbursement or other payment will be received. It is not intended toincrease or maximize payment by any payer. Similarly, nothing in this documentshould be viewed as instructions for selecting any particular code, and Abbott doesnot advocate or warrant the appropriateness of the use of any particular code.The ultimate responsibility for coding and obtaining payment/reimbursementremains with the customer. This includes the responsibility for accuracy andveracity of all coding and claims submitted to third-party payers. In addition, thecustomer should note that laws, regulations, and coverage policies are complex andare updated frequently, and, therefore, the customer should check with its localcarriers or intermediaries often and should consult with legal counsel or a financial,coding, or reimbursement specialist for any questions related to coding, billing,reimbursement or any related issues. This material reproduces information forreference purposes only. It is not provided or authorized for marketing use.Biventricular Pacing/ CardiacResynchronization Therapy (CRT)In certain circumstances, an additional lead may be required to achieve pacing ofthe left ventricle (biventricular pacing). In this event, the additional transvenouslead placement should be separately reported using 33224 or 33225. 33226 isreported for repositioning. See the Cardiac Resynchronization Therapy section,pages 27-38, for more information.ReferencesPages 2 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESABBOTT CODING GUIDECARDIAC PACEMAKERSEffective October 1, 2020ReferencesPages 3 of 54
RS (ICD)PHYSICIAN CODINGPAGE 1 PAGE 2CARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR TIONAL MEDICARE RATEFACILITYNON FACILITY7.14 476NA7.80 502NA8.52 546NA5.25 354NA5.52 371NA7.59 501NA3.14 241NASYSTEM IMPLANT OR REPLACEMENT332063320733208Insertion of new or replacement of permanent pacemaker with transvenous electrode(s);atrialInsertion of new or replacement of permanent pacemaker with transvenous electrode(s);ventricularInsertion of new or replacement of permanent pacemaker with transvenous electrode(s);atrial and ventricularGENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3322733228Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator;single lead systemRemoval of permanent pacemaker pulse generator with replacement of pacemaker pulse generator;dual lead systemSYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER33214Upgrade of implanted pacemaker system, conversion of single chamber system to dual chambersystem (includes removal of previously placed pulse generator, testing of existing lead, insertion ofnew lead, insertion of new pulse generator)GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33233Removal of permanent pacemaker pulse generator onlyNA There is no established Medicare payment in this setting.It is incumbent upon the physician to determine which, if any, modifiers should be used first.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 4 of 54
RS (ICD)PHYSICIAN CODINGPAGE 1 PAGE 2CARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR TIONAL MEDICARE RATEFACILITYNON FACILITYGENERATOR IMPLANT33212Insertion of pacemaker pulse generator only; with existing single lead5.01 336NA33213Insertion of pacemaker pulse generator only; with existing dual leads5.28 351NA4.85 355NARELOCATION OF SKIN POCKET33222Relocation of skin pocket for pacemakerLEAD PROCEDURES33216Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator5.62 389NA33217Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator5.59 384NA33215Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (rightatrial or right ventricular) electrode4.92 325NA33218Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator5.82 404NA33220Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator5.90 394NA33234Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular7.66 509NA33235Removal of transvenous pacemaker electrode(s); dual lead system9.90 668NANA There is no established Medicare payment in this setting.It is incumbent upon the physician to determine which, if any, modifiers should be used first.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 5 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTPAGE 1 PAGE 2ASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR PACEMAKERSHospital NATIONALMEDICARE RATEJ15223 10,251J15223 10,251J15223 10,251J15222 7,641J15223 10,251J15223 10,251Q25222 7,641SYSTEM IMPLANT OR REPLACEMENT332063320733208Insertion of new or replacement of permanent pacemaker with transvenous electrode(s);atrialInsertion of new or replacement of permanent pacemaker with transvenous electrode(s);ventricularInsertion of new or replacement of permanent pacemaker with transvenous electrode(s);atrial and ventricularGENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3322733228Removal of permanent pacemaker pulse generator with replacement of pacemaker pulsegenerator; single lead systemRemoval of permanent pacemaker pulse generator with replacement of pacemaker pulsegenerator; dual lead systemSYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER33214Upgrade of implanted pacemaker system, conversion of single-chamber system to dualchamber system (includes removal of previously placed pulse generator, testing of existinglead, insertion of new lead, insertion of new pulse generator)GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33233Removal of permanent pacemaker pulse generator onlyJ1 Hospital Part B services paid through a comprehensive APCQ2 T Packaged codesReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 6 of 54
INTROIMPLANTABLECARDIOVERTERDEFIBRILLATORS (ICD)PACEMAKERSPHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTPAGE 1 PAGE 2ASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR PACEMAKERSHospital NATIONALMEDICARE RATEGENERATOR IMPLANT33212Insertion of pacemaker pulse generator only; with existing single leadJ15222 7,64133213Insertion of pacemaker pulse generator only; with existing dual leadsJ15223 10,251T5054 1,62333216Insertion of a single transvenous electrode, permanent pacemaker or implantabledefibrillatorJ15222 7,64133217Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillatorJ15222 7,64133215Repositioning of previously implanted transvenous pacemaker or implantable defibrillator(right atrial or right ventricular) electrodeJ15183 2,77133218Repair of single transvenous electrode, permanent pacemaker or implantable defibrillatorT5221 2,98433220Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillatorT5221 2,98433234Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricularQ25221 2,98433235Removal of transvenous pacemaker electrode(s); dual lead systemQ25221 2,984RELOCATION OF SKIN POCKET33222Relocation of skin pocket for pacemakerLEAD PROCEDURESJ1 Hospital Part B services paid through a comprehensive APCT Significant procedure, multiple reduction appliesQ2 T Packaged codesReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 7 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCHOSPITAL INPATIENTPAGE 1 PAGE 2CARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR PACEMAKERSAmbulatory Surgery Center (ASC)4CPT‡CODEDESCRIPTIONPAYMENT MULTI-PROCEDURENATIONALINDICATORDISCOUNTMEDICARE RATESYSTEM IMPLANT OR REPLACEMENT332063320733208Insertion of new or replacement of permanent pacemaker with transvenouselectrode(s); atrialInsertion of new or replacement of permanent pacemaker with transvenouselectrode(s); ventricularInsertion of new or replacement of permanent pacemaker with transvenouselectrode(s); atrial and ventricularJ8Y 7,385J8Y 7,633J8Y 7,817J8Y 6,061J8Y 7,634J8Y 7,566J8N 5,353GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3322733228Removal of permanent pacemaker pulse generator with replacement of pacemakerpulse generator; single lead systemRemoval of permanent pacemaker pulse generator with replacement of pacemakerpulse generator; dual lead systemSYSTEM UPGRADE: SINGLE CHAMBER TO DUAL CHAMBER PACEMAKER33214Upgrade of implanted pacemaker system, conversion of single-chamber systemto dual-chamber system (includes removal of previously placed pulse generator,testing of existing lead, insertion of new lead, insertion of new pulse generator)GENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33233Removal of permanent pacemaker pulse generator onlyJ8 Device-intensive procedure; paid at adjusted rate.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 8 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCHOSPITAL INPATIENTPAGE 1 PAGE 2CARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR PACEMAKERSAmbulatory Surgery Center ROCEDURERATENATIONALMEDICARE RATEGENERATOR IMPLANT33212Insertion of pacemaker pulse generator only; with existing single leadJ8Y 6,20133213Insertion of pacemaker pulse generator only; with existing dual leadsJ8Y 7,710A2Y 820J8Y 5,469J8Y 6,673G2Y 1,341G2Y 1,508J8Y 2,127G2N 1,508J8N 1,951RELOCATION OF SKIN POCKET33222Relocation of skin pocket for pacemakerLEAD tion of a single transvenous electrode, permanent pacemaker orimplantable defibrillatorInsertion of 2 transvenous electrodes, permanent pacemaker or implantabledefibrillatorRepositioning of previously implanted transvenous pacemaker or implantabledefibrillator (right atrial or right ventricular) electrodeRepair of single transvenous electrode, permanent pacemaker or implantabledefibrillatorRepair of 2 transvenous electrodes for permanent pacemaker or implantabledefibrillatorRemoval of transvenous pacemaker electrode(s); single lead system, atrial orventricularRemoval of transvenous pacemaker electrode(s); dual lead systemG2 Non office-based surgical procedure added in CY2008 or later; payment base on OPPS relative payment rate.J8 Device-intensive procedure; paid at adjusted rate.A2 Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weightReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 9 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCCARDIAC DEVICEMONITORINGADDITIONAL CODESHOSPITAL INPATIENTPAGE 1 PAGE 2 PAGE 3CODING AND REIMBURSEMENT FOR PACEMAKERSHospital Inpatient3Note: report the combination of device insertion and/or lead(s) codes that best describes the procedure performedICD-10PCS CODE7DESCRIPTIONTYPICAL MS-DRGNATIONALASSIGNMENTMEDICARE RATEPERMANENT CARDIAC PACEMAKER IMPLANT (DRGs 242, 243 AND 04Z0JH834Z0JH605Z0JH635ZInsertion of cardiac rhythm related device into chest subcutaneous tissue and fascia, open approachInsertion of cardiac rhythm related device into chest subcutaneous tissue and fascia, percutaneousapproachInsertion of cardiac rhythm related device into abdomen subcutaneous tissue and fascia, openapproachInsertion of cardiac rhythm related device into abdomen subcutaneous tissue and fascia,percutaneous approachInsertion of pacemaker, single chamber into chest subcutaneous tissue and fascia, open approachInsertion of pacemaker, single chamber into chest subcutaneous tissue and fascia, percutaneousapproachInsertion of pacemaker, single chamber into abdomen subcutaneous tissue and fascia, openapproachInsertion of pacemaker, single chamber rate responsive into abdomen subcutaneous tissue andfascia, percutaneous approachInsertion of pacemaker, single chamber rate responsive into chest subcutaneous tissue and fascia,open approachInsertion of pacemaker, single chamber rate responsive into chest subcutaneous tissue and fascia,percutaneous approachCC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosisReferences242with MCC 23,926243with CC 16,278244withoutCC/MCC 13,277Effective Dates: October 1, 2020 - September 30, 2021Pages 10 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCCARDIAC DEVICEMONITORINGADDITIONAL CODESHOSPITAL INPATIENTPAGE 1 PAGE 2 PAGE 3CODING AND REIMBURSEMENT FOR PACEMAKERSHospital Inpatient3Note: report the combination of device insertion and/or lead(s) codes that best describes the procedure performedICD-10PCS CODE7DESCRIPTIONTYPICAL MS-DRGNATIONALASSIGNMENTMEDICARE RATEPERMANENT CARDIAC PACEMAKER IMPLANT (DRGs 242, 243 AND 244) continued0JH805Z0JH835ZInsertion of pacemaker, single chamber rate responsive into abdomen subcutaneous tissue andfascia, open approachInsertion of pacemaker, single chamber rate responsive into abdomen subcutaneous tissue andfascia, percutaneous approach0JH606ZInsertion of pacemaker, dual chamber into chest subcutaneous tissue and fascia, open approach0JH636ZInsertion of pacemaker, dual chamber into chest subcutaneous tissue and fascia, percutaneousapproach0JH806ZInsertion of pacemaker, dual chamber into abdomen subcutaneous tissue and fascia, open approach0JH836ZInsertion of pacemaker, dual chamber into abdomen subcutaneous tissue and fascia, percutaneousapproach02HK4JZInsertion of pacemaker lead into right ventricle, percutaneous endoscopic approach02HK3JZInsertion of pacemaker lead into right ventricle, percutaneous approach02HK0JZInsertion of pacemaker lead into right ventricle, open approachCC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosisReferences242with MCC 23,926243with CC 16,278244withoutCC/MCC 13,277Effective Dates: October 1, 2020 - September 30, 2021Pages 11 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCCARDIAC DEVICEMONITORINGADDITIONAL CODESHOSPITAL INPATIENTPAGE 1 PAGE 2 PAGE 3CODING AND REIMBURSEMENT FOR PACEMAKERSHospital Inpatient3Note: report the combination of device insertion and/or lead(s) codes that best describes the procedure performedICD-10PCS CODE7DESCRIPTIONTYPICAL MS-DRGNATIONALASSIGNMENTMEDICARE RATECARDIAC PACEMAKER DEVICE REPLACEMENT (DRGs 258 AND 259)0JPT0PZRemoval of cardiac rhythm related device from trunk subcutaneous tissue and fascia, openapproach0JPT3PZRemoval of cardiac rhythm related device from trunk subcutaneous tissue and fascia, percutaneousapproach258with MCC259without MCC 20,576 13,627CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT (DRGs 260, 261 AND 262)0JWT0PZRevision of cardiac rhythm related device in trunk subcutaneous tissue and fascia, open approach0JWT3PZRevision of cardiac rhythm related device in trunk subcutaneous tissue and fascia, percutaneousapproach02WA0MZ Revision of cardiac lead in heart, open approach02WA3MZRevision of cardiac lead in heart, percutaneous approach02WA4MZRevision of cardiac lead in heart, percutaneous endoscopic approachCC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosisReferences260with MCC261with CC262withoutCC/MCC 23,037 12,799 10,979Effective Dates: October 1, 2020 - September 30, 2021Pages 12 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESC-CODES DIAGNOSISCODING AND REIMBURSEMENT FOR PACEMAKERSHCPCS Device Category C-Codes5C-CODE DESCRIPTIONPACEMAKER GENERATOR IMPLANTC1785Pacemaker, dual-chamber, rate-responsive (implantable)C2621Pacemaker, other than single or dual-chamber (implantable)C2620Pacemaker, single-chamber, non-rate-responsive (implantable)C1786Pacemaker, single-chamber, rate-responsive (implantable)C2619Pacemaker, dual-chamber, non-rate-responsive (implantable)LEADSC1883Adapter/extension, pacing lead or neurostimulator (implantable)C1900Lead, left ventricular coronary venous systemC1898Lead, pacemaker, other than transvenous VDD single passC1779Lead, pacemaker, transvenous VDD single passEffective Dates: January 1, 2020 - December 31, 2020ReferencesPages 13 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESC-CODES DIAGNOSISCODING AND REIMBURSEMENT FOR PACEMAKERSICD-10-CM Diagnosis Codes6Diagnosis codes are used by both hospitals and physicians to document the indication for the procedure. For Cardiac Pacemaker, Implantable CardioverterDefibrillator (ICD) and Implantable/Insertable Cardiac Monitors (ICM) patients, there are many possible diagnosis code scenarios and a wide variety of possiblecombinations. The possible scenarios and combinations are too numerous to capture in this document. The customer should check with their local carriers orintermediaries and should consult with legal counsel or a financial, coding or reimbursement specialist for coding, reimbursement or billing questions related toICD-10-CM diagnosis codes.Effective Dates: January 1, 2020 - December 31, 2020ReferencesPages 14 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESABBOTT CODING GUIDEIMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD)Effective October 1, 2020ReferencesPages 15 of 54
RS (ICD)PHYSICIAN CODINGPAGE 1 PAGE 2CARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS L MEDICARE RATEFACILITYNON FACILITY14.92 961NA5.81 391NA6.08 406NA3.04 224NASYSTEM IMPLANT OR REPLACEMENT33249Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s),single or dual chamberGENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3326233263Removal of implantable defibrillator pulse generator with replacement of implantable defibrillatorpulse generator; single lead systemRemoval of implantable defibrillator pulse generator with replacement of implantable defibrillatorpulse generator; dual lead systemGENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33241Removal of implantable defibrillator pulse generator onlyGENERATOR IMPLANT33240Insertion of implantable defibrillator pulse generator only; with existing single lead5.80 382NA33230Insertion of implantable defibrillator pulse generator only; with existing dual lead6.07 400NA6.30 429NARELOCATION OF SKIN POCKET33223Relocation of skin pocket for implantable defibrillatorNA There is no established Medicare payment in this settingIt is incumbent upon the physician to determine which, if any, modifiers should be used first.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 16 of 54
RS (ICD)PHYSICIAN CODINGPAGE 1 PAGE 2CARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS L MEDICARE RATEFACILITYNON FACILITYLEAD PROCEDURES33216Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator5.62 389NA33217Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator5.59 384NA33215Repositioning of previously implanted transvenous pacemaker or implantable defibrillator(right atrial or right ventricular) electrode4.92 325NA33218Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator5.82 404NA33220Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator5.90 394NA33244Removal of single or dual chamber implantable defibrillator electrode(s); by transvenousextraction13.74 906NANA There is no established Medicare payment in this settingIt is incumbent upon the physician to determine which, if any, modifiers should be used first.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 17 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTPAGE 1 PAGE 2ASCIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)HOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS (ICD)Hospital NATIONALMEDICARE RATEJ15232 32,279J15231 22,710J15231 22,710Q25221 2,984SYSTEM IMPLANT OR REPLACEMENT33249Insertion or replacement of permanent implantable defibrillator system, with transvenouslead(s), single or dual chamberGENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3326233263Removal of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; single lead systemRemoval of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; dual lead systemGENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33241Removal of implantable defibrillator pulse generator onlyGENERATOR IMPLANT33240Insertion of implantable defibrillator pulse generator only; with existing single leadJ15231 22,71033230Insertion of implantable defibrillator pulse generator only; with existing dual leadJ15231 22,710T5054 1,623RELOCATION OF SKIN POCKET33223Relocation of skin pocket for implantable defibrillatorJ1 Hospital Part B services paid through a comprehensive APCQ2 T Packaged codesT Significant procedure, multiple reduction appliesReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 18 of 54
RS (ICD)PHYSICIAN CODINGIMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)CARDIACRESYNCHRONIZATIONTHERAPY (CRT)HOSPITAL OUTPATIENTPAGE 1 PAGE 2ASCHOSPITAL INPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS (ICD)Hospital NATIONALMEDICARE RATE33216Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillatorJ15222 7,64133217Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillatorJ15222 7,64133215Repositioning of previously implanted transvenous pacemaker or implantable defibrillator(right atrial or right ventricular) electrodeJ15183 2,77133218Repair of single transvenous electrode, permanent pacemaker or implantable defibrillatorT5221 2,98433220Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillatorT5221 2,98433244Removal of single or dual chamber implantable defibrillator electrode(s); by transvenousextractionQ25221 2,984LEAD(S)J1 Hospital Part B services paid through a comprehensive APCT Significant procedure, multiple reduction appliesQ2 T Packaged codesReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 19 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)IMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCHOSPITAL INPATIENTPAGE 1 PAGE 2HOSPITAL OUTPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS (ICD)Ambulatory Surgery Center4 (ASC)CPT‡CODEDESCRIPTIONPAYMENT MULTI-PROCEDUREINDICATORDISCOUNTNATIONALMEDICARE RATESYSTEM IMPLANT OR REPLACEMENT33249Insertion or replacement of permanent implantable defibrillator system, withtransvenous lead(s), single or dual chamberJ8Y 26,699J8Y 19,502J8Y 19,778G2N 1,508GENERATOR REMOVAL/REVISION (BATTERY REPLACEMENT)3326233263Removal of implantable defibrillator pulse generator with replacement ofimplantable defibrillator pulse generator; single lead systemRemoval of implantable defibrillator pulse generator with replacement ofimplantable defibrillator pulse generator; dual lead systemGENERATOR REMOVAL (BATTERY REMOVAL WITHOUT REPLACEMENT)33241Removal of implantable defibrillator pulse generator onlyGENERATOR IMPLANT33240Insertion of implantable defibrillator pulse generator only; with existing single leadJ8Y 19,74133230Insertion of implantable defibrillator pulse generator only; with existing dual leadJ8Y 19,949A2Y 820RELOCATION OF SKIN POCKET33223Relocation of skin pocket for implantable defibrillatorJ8 Device-intensive procedure; paid at adjusted rate.G2 Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.A2 Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.ReferencesEffective Dates: January 1, 2020 - December 31, 2020Pages 20 of 54
RS (ICD)PHYSICIAN CODINGCARDIACRESYNCHRONIZATIONTHERAPY (CRT)IMPLANTABLE/INSERTABLECARDIAC MONITORS (ICM)ASCHOSPITAL INPATIENTPAGE 1 PAGE 2HOSPITAL OUTPATIENTCARDIAC DEVICEMONITORINGADDITIONAL CODESCODING AND REIMBURSEMENT FOR IMPLANTABLE CARDIOVERTERDEFIBRILLATORS (ICD)4Ambulatory Surgery Center (ASC)CPT‡CODEDESCRIPTIONPAYMENT MULTI-PROCEDUREINDICATORDISCOUNTNATIONALMEDICARE RATELEAD PROCEDURES3321633217332153321833220Insertion of a single
atrial or right ventricular) electrode 4.92 325 NA 33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator 5.82 404 NA 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator 5.90 394 NA
