Congress Adjusts 2008 Final Physician Fee Schedule

Cardiac Rhythm Management Reimbursement Update

Last updated: July 2008

On July 16, 2008, Congressional action extended the adjustment of the Medicare and Medicaid Services (CMS) final rates for the 2008 Physician Fee Schedule (PFS) that applied to the first half of 2008. Rates will remain the same in the second half of 2008 as they were in the first half. Furthermore, Congress has instituted a 1.1% increase effective January 1, 2009 through December 31, 2009. We will publish an update with 2009 rates when the final PFS rule is published, which should be published around November 1, 2008.

Some of the changes that affect Cardiac Rhythm Management (CRM) and Electrophysiology (EP) procedures are detailed below. The rates are effective for physician services for the entire calendar year 2008.

Adjusted Final Base Payment Rates for 2008 Physician Fee Schedule for Common BSC CRM Related Procedures †

The table below shows the adjusted final 2008 Physician Fee Schedule base payment rates for several common BSC CRM related procedures and their percent change from 2007.

Common CPT Codes

Procedure

2008 vs.
2007

Base CPT
Reimbursement*

33208

Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

5%

$512

33214

Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

0%

$478

33224

Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of generator)

1%

$493

33226

Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion, and / or replacement of generator)

1%

$476

33240

Insertion of single- or dual-chamber pacing cardioverter-defibrillator pulse generator

0%

$458

33249

Insertion or repositioning of electrode lead(s) for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator

1%

$886

71090-26

Insertion of pacemaker, fluoroscopy and radiography, radiological supervision and interpretation

1%

$28

93641-26

Electrophysiologic evaluation of single- or dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single- or dual-chamber pacing cardioverter-defibrillator pulse generator

1%

$317

93743

Electronic analysis of pacing cardioverter defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recordings and interpretations of recordings at rest and during exercise, analysis of event markers and device response); dual-chamber, without reprogramming

1%

$82

† Rates effective through December 31, 2008.
* Final rates may vary due to geographic wage differences.

Adjusted Final Base Payment Rates for 2008 Physician Fee Schedule for Common BSC EP Related Procedures †

The table below shows the adjusted final 2008 Physician Fee Schedule base payment rates for several common BSC EP related procedures and their percent change from 2007.

Common CPT Codes

Procedure

2008 vs.
2007

Base CPT
Reimbursement*

92961

Cardioversion, elective, electrical conversion of arrhythmia; internal

0%

$251

93527 (-26)

Combined right heart catheterization and transseptal left heart catheterization through intact septum (with or without retrograde left heart catheterization)

0%

$400

93609 (-26)

Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure)

1%

$268

93613

Intracardiac electrophysiologic 3-dimensional mapping (List separately)

1%

$376

93619 (-26)

Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia

1%

$399

93620 (-26)

Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording

1%

$627

93621 (-26)

with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)

2%

$113

93622 (-26)

with left ventricular pacing and recording (List separately in addition to code for primary procedure)

1%

$165

93623 (-26)

Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)

1%

$153

93650

Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement

1%

$575

93651

Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination

1%

$870

93652

Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular tachycardia

1%

$948

93662 (-26)

Intracardiac echocardiography during therapeutic/ diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)

1%

$147

92987

Percutaneous balloon valvuloplasty; mitral valve

2%

$1,385

93532

Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies

-3%

$512

93580

Percutaneous transcatheter closure of congenital interatrial communication

1%

$970

93581

Percutaneous transcatheter closure of a congenital ventricular septal defect with implant

-1%

$1,283

† Rates effective through December 31, 2008.
* Final rates may vary due to geographic wage differences.

Additional Information

The Calendar Year 2009 Proposed Physician Fee Schedule was to experience a decrease in rates of 5.4%. However, in the July 16 law passed by Congress, CMS is directed to implement a 1.1% increase effective January 1, 2009. The final 2009 rates will be available in November, 2008. Payment amounts for many common electrophysiology procedures will now be subject to Medicare's multiple procedure discount rule.
Read Medicare's overview on the revised PFS
Read the full 2008 PFS Final Rule 1
For questions related to the reimbursement of CRM products, call 1-800-CARDIAC (1-800-227-3422) and ask for the reimbursement customer support center.

Disclaimer: The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct medical providers on how to use or bill for health care procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Boston Scientific assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for health care procedures.

This document represents no promise or guarantee by Boston Scientific concerning coverage, coding, billing, and payment levels. Boston Scientific specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document.

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