Shockwave Medical’s Intravascular Lithotripsy for ATK Procedures Receives Increased CMS Reimbursement in 2022 OPPS Final Rule

November 3, 2021—Shockwave Medical, Inc. announced that the Centers for Medicare & Medicaid Services (CMS) has reassigned the payment for peripheral intravascular lithotripsy (IVL) procedures performed on above-the-knee (ATK) arteries in the hospital outpatient setting as part of the calendar year (CY) 2022 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule. The resulting payment increases will become effective January 1, 2022.

Shockwave’s IVL technology was developed to treat complex calcified peripheral and coronary artery disease.

According to the company, 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, stents, or atherectomy. The new APC assignments will increase the payments hospitals receive for these procedures.

The relevant codes are as follows:

• HCPCS code C9764: Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with IVL, includes angioplasty within the same vessel(s), when performed
  • CY2021 APC assignment, 5192; final CY2021 payment, $4,957
  • CY2022 APC assignment, 5193; final CY2022 payment, $10,258
• HCPCS code C9765: Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with IVL, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed
  • CY2021 APC assignment, 5193; final CY2021 payment, $10,043
  • CY2022 APC assignment, 5194; final CY2022 payment, $16,402
• HCPCS code C9766: Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with IVL and atherectomy, includes angioplasty within the same vessel(s), when performed
  • CY2021 APC assignment, 5193; final CY2021 payment, $10,043
  • CY2022 APC assignment, 5194; final CY2022 payment, $16,402

The APC assignments for the remaining peripheral IVL HCPCS codes (C9767, C9772, C9773, C9774, C9775) remain unchanged, advised Shockwave Medical.

Doug Godshall, President and Chief Executive Officer of Shockwave Medical, commented in the company’s press release, “We appreciate CMS’s collaborative relationship and their swift action in reassigning payment levels for IVL performed ATK, as the data acknowledge the resources associated with performing IVL in these patients.”

He continued, “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.”

Finally, Mr. Godshall stated, “We would like to acknowledge CMS for making an exception to this year’s standard ratesetting process by considering CY 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.”