Reimbursement
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.
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-10, and HCPCS coding, as well as typical DRG payments for procedures related to our products.
2021 facility and physician billing guide
Physicians use Current Procedural Terminology (CPT) codes to bill for procedures and services. Category I CPT codes are assigned unique relative value units (RVUs), which are used to determine payment by the Centers for Medicare and Medicaid Services (CMS). Category I CPT codes have been implemented for transcatheter aortic valve replacement (TAVR) and transcatheter pulmonary valve replacement (TPVR) procedures. Clinicians use CPT Category III codes to track the use of emerging technology, services, and procedures for clinical efficacy, utilization and outcomes, and to facilitate billing. Category III codes are temporary and do not have relative value units (RVUs) assigned to them unlike the “permanent” CPT Category I codes. Payment has not been established and is therefore based on carrier discretion rather than a yearly fee schedule. The American Medical Association (AMA) has released Category III codes for the use of transcatheter mitral valve-in-valve (MViV) technology. When using Category III codes, clinicians are required to submit a paper claim along with an operative report describing the procedure in order to justify the clinician’s fee. All providers should review the patient’s plan/medical policy prior to scheduling surgery to ensure the payer does not have a non-coverage policy. Several payers have non-coverage for MViV that are unrelated to Category III designation.
| Potential CPT Code | Description | CY2021 Medicare National Avg. Physician Payment | Each Physician Payment (Modifier-62) | CY2021 Facility RVUs |
|---|---|---|---|---|
| Transcatheter Aortic Valve Replacement (TAVR) | ||||
| 33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | $1,233 | $771 | 35.34 |
| 33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | $1,343 | $839 | 38.50 |
| 33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | $1,393 | $871 | 39.93 |
| 33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | $1,394 | $871 | 39.95 |
| 33365 | Transcatheter aortic valve replacement aortic approach (e.g., median sternotomy, (TAVR/TAVI) with prosthetic valve; transmediastinotomy) | $1,452 | $908 | 41.62 |
| 33366 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (e.g., left thoracotomy) | $1,602 | $1,001 | 45.90 |
| TAVR Add-on Codes | ||||
| 33367 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (list separately in addition to code for primary procedure) | $640 | NA | 18.35 |
| 33368 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure) | $756 | NA | 21.66 |
| 33369 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure) | $998 | NA | 28.60 |
| Unlisted Code for Alternative TAVR Approach (e.g. subcaval, subclavian, carotid) | ||||
| 33399 | Unlisted procedure cardiac surgery | Code should be submitted with a TAVR crosswalk code (e.g. CPTs 33361 – 33366). Identify a crosswalk code of similar RVUs to the unlisted procedure being performed. | ||
| Additional Notes for Physician Inpatient Coding for TAVR | ||||
- Place of service (POS) code 21 (inpatient hospital)
- Modifier 62 (two surgeons/co-surgeons)
- Modifier Q0 (zero) signifying CED participation (qualifying registry or qualified clinical study)
- ICD-10 secondary diagnosis code Z00.6 (encounter for examination for normal comparison and control in clinical research program)
- Clinical Trial (CT) number (e.g. the CT number for the TVT Registry is CT01737528)
- As per American Medical Association (AMA) requirements for TAVR, TAVR is a two-physician (IC & CS) procedure. Payment for each physician is 62.5% of the established national average payment. +33367,33368 and 33369 are add-on codes which do not require modifier 62 hence each physician payment of 62.5% does not apply.
- Codes 33361-33369 have a 0-day global period and do not include cardiac catheterization [93451-93572] when performed at the time of the procedure for diagnostic purposes prior to aortic valve replacement. Codes 33361 - 33369 include all other catheterization[s], temporary pacing, intraprocedural contrast injection[s], fluoroscopic radiological supervision and interpretation, and imaging guidance, which are not reported separately when performed to complete the aortic valve procedure.
- Code also modifier 59 when diagnostic coronary angiography procedures are performed as separate and distinct procedural services on the same day or session as TAVR/TAVI
| Potential CPT Code | Description | CY2021 Medicare National Avg. Physician Payment | CY2021 Facility RVUs |
|---|---|---|---|
| Transcatheter Mitral Valve-in-Valve (MViV) | |||
| 0483T Category III | Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed | Based on carrier discretion | NA |
| 0484T Category III | Transthoracic exposure (e.g.,thoracotomy, transapical) | Based on carrier discretion | NA |
| Transcatheter Mitral Valve-in-Ring (MViR) | |||
| 33999 | Unlisted cardiac procedure surgery | Code should be submitted with a transcatheter valve replacement crosswalk code (e.g. CPTs 33361 - 33366). Identify a crosswalk code of similar RVUs to the unlisted procedure being performed. | |
| Transcatheter Pulmonary Valve Replacement (TPVR) | |||
| 33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | $1,381 | 39.58 |
Medicare inpatient hospital reimbursement is based upon the Medicare Severity Diagnostic-Related Group (MS-DRG) classification system, which assigns MS-DRGs based on ICD-10-CM diagnosis and procedure codes. Pursuant to the final rule for the FY 2015 hospital Inpatient Prospective Payment System (IPPS), CMS created separate MS-DRGs for endovascular cardiac valve replacements, effective October 1, 2014. The following MS-DRGs generally describe hospital inpatient reimbursement for endovascular cardiac valve replacement procedures, including TAVR, TPVR, MViR and MViV procedures.
| MS-DRG | Description | FY2021 Relative Weight | FY2021 Medicare National Average Base Payment | FY2021 Geometric Mean LOS |
|---|---|---|---|---|
| Endovascular Cardiac Valve Replacement Procedures | ||||
| 266 | Endovascular cardiac valve replacement and supplement procedures with MCC | 7.0972 | $45,617 | 3.2 |
| 267 | Endovascular cardiac valve replacement and supplement procedures without MCC | 5.6009 | $36,000 | 1.7 |
| Potential ICD-10- Procedure Code | Description |
|---|---|
| Transcatheter Aortic Valve Replacement (TAVR) | |
| 02RF38Z | Replacement of aortic valve with zooplastic tissue, percutaneous approach |
| 02RF38H | Replacement of aortic valve with zooplastic tissue, transapical, percutaneous approach |
Medicare will only pay TAVR physician claims for ICD-10-PCS codes 02RF38Z and 02RF38H when billed with the following*
* Medicare will return all other claims as unprocessable
|
|
| Transcatheter Mitral Valve-in-Valve (MViV) | |
| 02RG38Z | Replacement of mitral valve with zooplastic tissue, percutaneous approach |
| 02RG38H | Replacement of mitral valve with zooplastic tissue, transapical, percutaneous approach |
| Transcatheter Mitral Valve-in-Ring (MViR) | |
| 02UH38Z | Supplement of mitral valve with synthetic substitute, percutaneous approach |
| Transcatheter Pulmonary Valve Replacement (TPVR) | |
| 02RH38Z | Replacement of pulmonary valve with zooplastic tissue, percutaneous approach |
| Potential ICD-10- Diagnosis Code | Description |
|---|---|
| Aortic Stenosis | |
| I35.0 | Nonrheumatic aortic (valve) stenosis |
| Bicuspid Valve | |
| Q23.0 | Congenital stenosis of the aortic valve |
| Potential ICD-10- Diagnosis Code | Description |
|---|---|
| Valve-in-Valve or Transcatheter Mitral Valve-in-Ring
(failed aortic surgical or transcatheter bioprosthetic, failed mitral surgical bioprosthetic, or failed pulmonic surgical bioprosthetic)
|
|
| T82.222A | Displacement of biological heart valve graft, initial encounter
(e.g. Previously placed valve was malpositioned or became displaced)
|
| T82.857A | Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter
(e.g. Previously placed valve developed stenosis prematurely)
|
| T82.223A | Leakage of biological heart valve graft, initial encounter
(e.g. Previously placed valve developed regurgitation prematurely)
|
| Z45.09 | Encounter for adjustment and management of other cardiac device
(e.g. Previously placed valve developed stenosis or regurgitation as an expected occurrence as it degenerates toward valve end-of-life)
|
| Transcatheter Pulmonary Valve Replacement (TPVR) Congenital Malformations | |
| Q20.0 | Common arterial trunk |
| Q20.1 | Double outlet right ventricle |
| Q20.3 | Discordant ventriculoarterial connection |
| Q20.5 | Discordant atrioventricular connection |
| Q21.3 | Tetralogy of Fallot |
| Q22.0 | Pulmonary valve atresia |
| Q22.1 | Congenital pulmonary valve stenosis |
| Q22.2 | Congenital pulmonary valve insufficiency |
| Q22.3 | Other congenital malformations of pulmonary valve |
| Q25.5 | Atresia of pulmonary artery |
| Q25.6 | Stenosis of pulmonary artery |
| Q25.71 | Coarctation of pulmonary artery |
| Q25.72 | Congenital pulmonary arteriovenous malformation |
| Q25.79 | Other congenital malformations of pulmonary artery |
| Z87.74 | Personal history of (corrected) congenital malformations of heart and circulatory system
(e.g. Factors influencing health status and contact with health services)
|
| Z98.89 | Other specified postprocedural states
(e.g. Factors influencing health status and contact with health services)
|
Outpatient Hospital Billing
Hospitals use CPT codes when billing for procedures in the outpatient setting. Medicare pays for many procedures performed in the outpatient hospital setting under a prospective payment system. However, Medicare does not reimburse for outpatient services they do not believe maybe safely done in the outpatient hospital setting for their patient population. CMS has designated transcatheter heart valve procedures to be inpatient only procedures, meaning the hospital will not receive payment from Medicare should it be performed in an outpatient setting.
Commercial Payer Billing
Each non-Medicare payer has its own methodology for paying providers. Edwards recommends checking the patient’s payer medical policy and your payer contracts to determine potential payments and if the procedure will be covered. The best way to determine if the procedure will be covered is to submit a preauthorization/pre-determination request to the patient’s payer prior to scheduling the surgery.
Additional information may be available at the Edwards Lifesciences Reimbursement Hotline: (303) 524-3854 or edwards@rpihotline.com
Disclaimer
Important – Please Note:
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 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. All codes referenced herein are examples only and may not be all-inclusive. Laws, regulations, coverage policies and code sets (i.e., CPT, ICD-10, and HCPCS) are complex and updated frequently. Coding should be based on the medical record documentation and the code sets in effect at the time of service.
Indications: The Edwards SAPIEN 3 and SAPIEN 3 Ultra Transcatheter Heart Valve system is indicated for relief of aortic stenosis in patients with symptomatic heart disease due to severe native calcific aortic stenosis who are judged by a Heart Team, including a cardiac surgeon, to be appropriate for the transcatheter heart valve replacement therapy.
The Edwards SAPIEN 3 and SAPIEN 3 Ultra Transcatheter Heart Valve system is indicated for patients with symptomatic heart disease due to failing (stenosed, insufficient, or combined) of a surgical or transcatheter bioprosthetic aortic valve or surgical bioprosthetic mitral valve who are judged by a heart team, including a cardiac surgeon, to be at high or greater risk for open surgical therapy (i.e., predicted risk of surgical mortality ≥ 8% at 30 days, based on the Society of Thoracic Surgeons (STS) risk score and other clinical co-morbidities unmeasured by the STS risk calculator).
Contraindications: The valves and delivery systems are contraindicated in patients who cannot tolerate an anticoagulation/antiplatelet regimen or who have active bacterial endocarditis or other active infections.
Warnings: Observation of the pacing lead throughout the procedure is essential to avoid the potential risk of pacing lead perforation. There may be an increased risk of stroke in transcatheter aortic valve replacement procedures, as compared to balloon aortic valvuloplasty or other standard treatments in high or greater risk patients. Incorrect sizing of the valve may lead to paravalvular leak, migration, embolization, residual gradient (patient-prosthesis mismatch), and/or annular rupture. Accelerated deterioration of the valve due to calcific degeneration may occur in children, adolescents, or young adults and in patients with an altered calcium metabolism. Prior to delivery, the valve must remain hydrated at all times and cannot be exposed to solutions other than its shipping storage solution and sterile physiologic rinsing solution. Valve leaflets mishandled or damaged during any part of the procedure will require replacement of the valve. Caution should be exercised in implanting a valve in patients with clinically significant coronary artery disease. Patients with pre-existing bioprostheses should be carefully assessed prior to implantation of the valve to ensure proper valve positioning and deployment. Do not use the valve if the tamper-evident seal is broken, the storage solution does not completely cover the valve, the temperature indicator has been activated, the valve is damaged, or the expiration date has elapsed. Do not mishandle the delivery system or use it if the packaging or any components are not sterile, have been opened or are damaged (e.g., kinked or stretched), or if the expiration date has elapsed. Use of excessive contrast media may lead to renal failure. Measure the patient’s creatinine level prior to the procedure. Contrast media usage should be monitored. Patient injury could occur if the delivery system is not un-flexed prior to removal. Care should be exercised in patients with hypersensitivities to cobalt, nickel, chromium, molybdenum, titanium, manganese, silicon, and/or polymeric materials. The procedure should be conducted under fluoroscopic guidance. Some fluoroscopically guided procedures are associated with a risk of radiation injury to the skin. These injuries may be painful, disfiguring, and long-lasting. Valve recipients should be maintained on anticoagulant/antiplatelet therapy, except when contraindicated, as determined by their physician. This device has not been tested for use without anticoagulation. Do not add or apply antibiotics to the storage solution, rinse solution, or to the valve. Balloon valvuloplasty should be avoided in the treatment of failing bioprostheses as this may result in embolization of bioprosthesis material and mechanical disruption of the valve leaflets.Do not perform stand-alone balloon aortic valvuloplasty procedures in the INSPIRIS RESILIA aortic valve for the sizes 19-25 mm. This may expand the valve causing aortic incompetence, coronary embolism or annular rupture.To prevent possible damage to the balloon shaft, ensure that the proximal end of the balloon shaft is not subjected to bending. Ensure there is no residual fluid left in the balloon to avoid potential difficulty with valve alignment during the procedure. Do not position the valve past the distal Valve Alignment Marker. This will prevent proper valve deployment. If valve alignment is not performed in a straight section, there may be difficulties performing this step which may lead to delivery system damage and inability to inflate the balloon. Utilizing alternate fluoroscopic views may help with assessing curvature of the anatomy. If excessive tension is experienced during valve alignment, repositioning the delivery system to a different straight section of the aorta and relieving compression (or tension) in the system will be necessary.
Precautions: Long-term durability has not been established for the valve. Regular medical follow-up is advised to evaluate valve performance. Limited clinical data are available for transcatheter aortic valve replacement in patients with a congenital bicuspid aortic valve who are deemed to be at low surgical risk. Anatomical characteristics should be considered when using the valve in this population. In addition, patient age should be considered as long-term durability of the valve has not been established. Glutaraldehyde may cause irritation of the skin, eyes, nose, and throat. Avoid prolonged or repeated exposure to, or breathing of, the solution. Use only with adequate ventilation. If skin contact occurs, immediately flush the affected area with water; in the event of contact with eyes, seek immediate medical attention. For more information about glutaraldehyde exposure, refer to the Safety Data Sheet available from Edwards Lifesciences. To maintain proper valve leaflet coaptation, do not overinflate the deployment balloon. Appropriate antibiotic prophylaxis is recommended post-procedure in patients at risk for prosthetic valve infection and endocarditis. Additional precautions for transseptal replacement of a failed mitral valve bioprosthesis include, the presence of devices or thrombus or other abnormalities in the caval vein precluding safe transvenous femoral access for transseptal approach; and the presence of an Atrial Septal Occluder Device or calcium or abnormalities in the atrial septum preventing safe transseptal access. Special care must be exercised in mitral valve replacement if chordal preservation techniques were used in the primary implantation to avoid entrapment of the subvalvular apparatus. Safety and effectiveness have not been established for patients with the following characteristics/comorbidities: non-calcified aortic annulus; severe ventricular dysfunction with ejection fraction < 20%; congenital unicuspid aortic valve; pre-existing prosthetic ring in any position; severe mitral annular calcification (MAC); severe (> 3+) mitral insufficiency, or Gorlin syndrome; blood dyscrasias defined as leukopenia (WBC < 3000 cells/mL), acute anemia (Hb < 9 g/dL), thrombocytopenia (platelet count < 50,000 cells/mL), or history of bleeding diathesis or coagulopathy; hypertrophic cardiomyopathy with or without obstruction (HOCM); echocardiographic evidence of intracardiac mass, thrombus, or vegetation; a known hypersensitivity or contraindication to aspirin, heparin, ticlopidine (Ticlid), or clopidogrel (Plavix), or sensitivity to contrast media, which cannot be adequately premedicated; significant aortic disease, including abdominal aortic or thoracic aneurysm defined as maximal luminal diameter 5 cm or greater, marked tortuosity (hyperacute bend), aortic arch atheroma (especially if thick [> 5 mm], protruding, or ulcerated) or narrowing (especially with calcification and surface irregularities) of the abdominal or thoracic aorta, severe “unfolding” and tortuosity of the thoracic aorta; bulky calcified aortic valve leaflets in close proximity to coronary ostia; a concomitant paravalvular leak where the failing bioprosthesis is not securely fixed in the native annulus or is not structurally intact (e.g., wireform frame fracture); or a partially detached leaflet of the failing bioprosthesis that in the aortic position may obstruct a coronary ostium. For Left axillary approach, a left subclavian takeoff angle ~ ≥ 90° from the aortic arch causes sharp angles, which may be responsible for potential sheath kinking, subclavian/axillary dissection and aortic arch damage. Ensure there is flow in Left Internal Mammary Artery (LIMA)/Right Internal Mammary Artery (RIMA) during procedure and monitor PA pressure in homolateral radial artery. Residual mean gradient may be higher in a “THV-in-failing bioprosthesis” configuration than that observed following implantation of the valve inside a native aortic annulus using the same size device. Patients with elevated mean gradient post procedure should be carefully followed. It is important that the manufacturer, model and size of the preexisting bioprosthetic valve be determined, so that the appropriate valve can be implanted and a prosthesis-patient mismatch be avoided. Additionally, pre-procedure imaging modalities must be employed to make as accurate a determination of the inner diameter as possible.
Potential Adverse Events: Potential risks associated with the overall procedure, including potential access complications associated with standard cardiac catheterization, balloon valvuloplasty, the potential risks of conscious sedation and/or general anesthesia, and the use of angiography: death; stroke/transient ischemic attack, clusters, or neurological deficit; paralysis; permanent disability; respiratory insufficiency or respiratory failure; hemorrhage requiring transfusion or intervention; cardiovascular injury including perforation or dissection of vessels, ventricle, atrium, septum, myocardium, or valvular structures that may require intervention; pericardial effusion or cardiac tamponade; thoracic bleeding; embolization including air, calcific valve material, or thrombus; infection including septicemia and endocarditis; heart failure; myocardial infarction; renal insufficiency or renal failure; conduction system defect which may require a permanent pacemaker; arrhythmia; retroperitoneal bleed; arteriovenous (AV) fistula or pseudoaneurysm; reoperation; ischemia or nerve injury or brachial plexus injury; restenosis; pulmonary edema; pleural effusion; bleeding; anemia; abnormal lab values (including electrolyte imbalance); hypertension or hypotension; allergic reaction to anesthesia, contrast media, or device materials; hematoma; syncope; pain or changes at the access site; exercise intolerance or weakness; inflammation; angina; heart murmur; and fever. Additional potential risks associated with the use of the valve, delivery system, and/or accessories include: cardiac arrest; cardiogenic shock; emergency cardiac surgery; cardiac failure or low cardiac output; coronary flow obstruction/transvalvular flow disturbance; device thrombosis requiring intervention; valve thrombosis; device embolization; device migration or malposition requiring intervention; left ventricular outflow tract obstruction; valve deployment in unintended location; valve stenosis; structural valve deterioration (wear, fracture, calcification, leaflet tear/tearing from the stent posts, leaflet retraction, suture line disruption of components of a prosthetic valve, thickening, stenosis); device degeneration; paravalvular or transvalvular leak; valve regurgitation; hemolysis; device explants; nonstructural dysfunction; mechanical failure of delivery system and/or accessories; and non-emergent reoperation.
Edwards CrimperIndications:The Edwards crimper is indicated for use in preparing the Edwards SAPIEN 3 Ultra transcatheter heart valve and the Edwards SAPIEN 3 transcatheter heart valve for implantation.
Contraindications:There are no known contraindications.
Warnings:The devices are designed, intended, and distributed for single use only.Do not resterilize or reuse the devices.There are no data to support the sterility, nonpyrogenicity, and functionality of the devices after reprocessing.
Precautions:For special considerations associated with the use of the Edwards crimper prior to THV implantation, refer to the THV Instructions for Use.
Potential Adverse Events:There are no known potential adverse events associated with the Edwards crimper.
CAUTION: Federal (United States) law restricts these devices to sale by or on the order of a physician.
References
- Current Procedure Terminology (CPT) copyright 2020, American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.
- Not all codes provided are applicable for the clinical scenarios in which Edwards Lifesciences’ Transcatheter Heart Valve technologies are used. The provider is responsible for selecting the most appropriate code(s) for the patient’s clinical presentation. When diagnostic services are performed, it may be appropriate to add applicable codes according to the service provided following the correct coding guidelines. Services that are considered a component of another procedure may not always be coded and billed separately.
- Centers for Medicare & Medicaid Services. CY2021 Physician Fee Schedule (MPFS) Final Rule. Payments are effective January 1, 2021 through December 31, 2021.
- Centers for Medicare & Medicaid Services. FY2021 Inpatient Prospective Payment System (IPPS) Final Rule Correction Notice. Payments are effective October 1, 2020 through September 30, 2021.
- International Classification of Diseases, 10th Revision, Clinical Modification 2021 ICD-10-CM and PCS Expert for hospitals, volume 1,2, and 3.
2021 facility and physician billing guide
Reimbursement hotline: (303) 524-3854 or edwards@rpihotline.com
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 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.
2020 facility and physician billing guide
Reimbursement hotline: (303) 524-3854 or edwards@rpihotline.com
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.
2020 facility and physician billing guide
Reimbursement hotline: (303) 524-3854 or edwards@rpihotline.com
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.
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