Payment Structure for Hospital Outpatient Services

Last updated: November 07

This page contains Medicare hospital outpatient payment structure for Boston Scientific products and related procedures. Current outpatient base reimbursement rates can
be found here.

Ambulatory Payment Classifications (APCs)¹ ²

CRT-Ds	CRT-Ps	ICDs	Pacemakers Implantable	Pacemakers Temporary	Code	Description
x	x	x	x		APC 0027	Level IV skin repair
x		x			APC 0084	Level I electrophysiologic evaluation
			x		APC 0089	Insertion/replacement of permanent pacemaker and electrodes
			x		APC 0090	Insertion/replacement of pacemaker pulse generator
x	x	x	x		APC 0105	Revision/removal of pacemakers, AICD, or vascular
x	x	x	x	x	APC 0106	Insertion/replacement/repair of pacemaker and/or electrodes
x		x			APC 0107	Insertion of cardioverter-defibrillator
x		x			APC 0108	Insertion/replacement/repair of cardioverter-defibrillator leads
x	x				APC 0269	Level III echocardiogram except transesophageal
x	x				APC 0418	Insertion of left ventricular pacing elect.
	x		x		APC 0654	Insertion/replacement of a permanent dual chamber pacemaker
	x	x			APC 0655	Insertion/replacement/conversion of a permanent dual chamber pacemaker
x	x				APC 0671	Level II echocardiogram except transesophageal
x		x			APC 0689	Electronic analysis of cardioverter-defibrillators
	x		x		APC 0690	Electronic analysis of pacemakers and other cardiac devices
x	x				APC 0697	Level I echocardiogram except transesophageal
x	x				APC 1525	New technology—level XXV ($3500-$4000)

69 Federal Register, No. 219 (November 15, 2004) (codified at 42 CFR §419).
Centers for Medicare and Medicaid Services. CY 2005 Hospital Outpatient Prospective Payment System; Changes to the Hospital Outpatient Perspective Payment System for Calendar Year 2005. CMS-1427-CN; Federal Register December 30, 2004. CMS-1427-FC; Federal Register November 15, 2004. APCs: Supporting Data Files- Addenda A, B and C. C Codes: Revised list of Device Codes Required for Procedure Codes in Selected Device Dependent APCs and Table 20. Available at: http://www.cms.hhs.gov/providers/hopps/2005fc/1427fc.asp Accessed January 14, 2005.

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