New CMS Codes Establish Specific Payment for Intravascular Lithotripsy Performed BTK

December 4, 2020—Shockwave Medical, Inc. announced that the Centers for Medicare & Medicaid Services (CMS) has created four new codes for intravascular lithotripsy (IVL) procedures performed in the tibial and peroneal arteries (below the knee [BTK]) in the hospital outpatient setting. These codes will be effective January 1, 2021, as part of the calendar year 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule.

Shockwave Medical reported the following:

• CMS created the four new Healthcare Common Procedure Coding System (HCPCS) codes (C9772-C9775) noting that “…resources associated with tibial and peroneal IVL procedures are higher than iliac, femoral, and popliteal procedures.”
• In July 2020, CMS issued four codes C9764-C9767 to describe IVL performed in all lower extremity arteries.
• As part of the 2021 OPPS final rule, these initial codes have now been redefined to report IVL procedures performed in lower extremity arteries, except tibial and peroneal.
• Starting in January 2021, there will now be four codes that pertain to below-the-knee IVL procedures and four that pertain to above-the-knee IVL procedures.

In addition, CMS assigned the new HCPCS codes to Ambulatory Payment Classifications (APCs) that determine hospital outpatient payment. These APC assignments are consistent with similar interventional procedures performed in the BTK arteries.

Also effective January 1, 2021, CMS added IVL procedures to the list of services covered in an Ambulatory Surgical Center setting.

“We appreciate CMS’s swift action in adding these new codes as they acknowledge the differentiation between above-the-knee and below-the-knee procedures and that complex BTK interventions involving IVL require more resources,” commented Doug Godshall, President and Chief Executive Officer of Shockwave Medical, in the company’s announcement.

“Importantly, we believe these new HCPCS codes, which now increase payment for IVL procedures performed BTK, will further facilitate access to IVL technology for Medicare patients, while also allowing data collection specific to IVL procedures performed BTK. We are grateful for the support that came from multiple medical societies during the public comment period, as well as CMS’ Outpatient Physician Advisory panel. We look forward to continued engagement with CMS as the addition of these new codes will enable the collection of cost data on IVL procedures in a more specific way, which we believe will better enable the agency to make appropriate adjustments to procedure payment levels in the future.”