Congress Reduces 2007 Final Physician Fee Schedule Cuts

Cardiac Rhythm Management Reimbursement Update

Last updated: January 2007

On December 20th, 2006, President George W. Bush signed the Tax Relief and Health Care Act of 2006. The Law reduced the amounts of cuts to the final Physician Fee Schedule as proposed by the Centers for Medicare and Medicaid Services (CMS). Some of the final changes that affect cardiac rhythm management (CRM) procedures are detailed below. The changes go into effect for services on or after January 1, 2007.

Final Base Payment Changes for 2007 Physician Fee Schedule for Common BSC CRM Related Procedures

The table below shows the final CY07 Physician Fee Schedule base payment rates for several common BSC CRM related procedures and their percent change from CY06. While procedure implant reimbursement rates are down, reimbursement for other routine evaluation and management services are up.


Common CPT Codes	Procedure	CY07* vs. CY06	Base CPT Reimbursement**
33208	Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular	-4.8%	$486
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)	-4.6%	$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)	-4.7%	$491
33226	Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion, and / or replacement of generator)	-4.6%	$474
33240	Insertion of single- or dual-chamber pacing cardioverter-defibrillator pulse generator	-4.3%	$456
33249	Insertion or repositioning of electrode lead(s) for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator	-0.8%	$878
71090-26	Insertion of pacemaker, fluoroscopy and radiography, radiological supervision and interpretation	-4.5%	$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	-4.3%	$314

* The percent changes shown are base payments and will vary for individual hospitals. See your Boston Scientific sales representative to find out how your hospital is affected.

** Final rates may vary due to geographic wage differences.

Additional Information

Read White House's press release

Read the Tax Relief and Health Care Act of 2006

Read the full PFS Final Rule

For questions related to the reimbursement of CRM products, call 1-800-CARDIAC (1-800-227-3422) and ask for the reimbursement call center.

Disclaimer: The information provided on this website 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 on this website 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 healthcare 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 healthcare procedures.

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