Reimbursement

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Reimbursement

Edwards Lifesciences is committed to supporting our customers with reimbursement resources to assist with coverage, coding, and reimbursement for our products. We have several tools below which may assist you in determining the appropriate code(s) to utilize when billing for products and procedures as well as the nationally averaged reimbursement amounts.

HCPCS C Code Finder

The Health Care Common Procedural Coding System (HCPCS) C Code Finder allows you to find the appropriate HCPCS C Code, if applicable, for a specific Edwards product. C codes are used in conjunction with the Medicare prospective payment system for outpatient hospital procedures only. C codes do not apply to inpatient surgical procedures, but should be added to the hospital’s chargemaster to report device costs used in the outpatient setting. Medicare created C codes to track device cost information for future APC rate-setting purposes.

Please enter the Edwards model number

Facility and Physician Billing Guides

These billing guides are intended to provide information to clinicians regarding appropriate coding, coverage, and payment for procedures performed with the Edwards Lifesciences products. These guides contain information regarding most commonly billed CPT, ICD-9, and HCPCS coding, as well as typical DRG payments for procedures related to our products.

Reimbursement Assistance

For further assistance with questions which are not answered by the resources above, please contact our
Reimbursement Assistance support team and one of our representatives will contact you shortly.

Reimbursement information provided by Edwards Lifesciences is gathered from third-party sources and is presented for informational purposes only. Edwards makes no representation, warranty or guarantee as to the timeliness, accuracy or completeness of the information and such information is not, and should not be construed as reimbursement, coding or legal advice. Any and all references to reimbursement codes are provided as examples only and are not intended to be a recommendation or advice as to the appropriate code for the a particular patient, diagnosis, product or procedure or a guarantee or promise of coverage or payment, nor does Edwards Lifesciences warranty that codes listed are appropriate in all related clinical scenarios. It is the responsibility of the provider to determine if coverage exists and what requirements are necessary for submitting a proper claim for reimbursement to a health plan or payer, including the appropriate code(s) for products provided or services rendered. Laws, regulations, and payer policies concerning reimbursement are complex and change frequently; service providers are responsible for all decisions relating to coding and reimbursement submissions. Medicare’s Correct Coding Initiative and commercial payer policies are reviewed and updated several times each year. Accordingly, Edwards strongly recommends consultation with payers, reimbursement specialists and/or legal counsel regarding appropriate product or procedure codes, coverage, and reimbursement matters.