CMS
CMS

Reimbursement
for Model D

Healthcare professionals / Gastroenterology / EXALTTM Model D Single-Use Duodenoscope / Pass-through Payment

 

New Technology Add-on Payment (NTAP)

Boston Scientific continues to lead the effort to secure appropriate coding and payment for EXALT Model D.

  • Medicare Hospital Inpatient New Technology Add-on Payment (NTAP): The Centers for Medicare & Medicaid Services (CMS) has approved Boston Scientific’s application for new technology add-on payment applicable to EXALT Model D.  The intent of NTAP is to facilitate Medicare patient access to new and innovative devices, like EXALT Model D, by providing eligible cases with additional payment for the device over and above the MS-DRG payment for a Medicare hospital inpatient admission.  NTAP will be effective October 1, 2021. 
  • Inpatient ICD-10-PCS Procedure Codes: In response to Boston Scientific's request, CMS created two unique ICD-10-PCS procedure codes for hospitals to facilitate reporting the use of single-use duodenoscopes when used in the hospital inpatient setting.  Beginning October 1, 2021, hospitals may use the following ICD-10-PCS procedure codes to report the use of EXALT Model D on their claims.   

ICD-10-PCS Code

Descriptor

XFJB8A7

Inspection of hepatobiliary duct using single-use duodenoscope

XFJD8A7

Inspection of pancreatic duct using single-use duodenoscope

 Source: 2022 ICD-10-PCS Addendum June 4, 2021. https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs
Commercial payers are not required to follow CMS coverage; however, some may choose to do so.  It is recommended to reach out to commercial payers to understand commercial payer reimbursement for EXALT Model D.
    

CMS Transitional Pass-through (TPT) Payment Category

In 2020, the Centers for Medicare & Medicaid Services (CMS) approved Boston Scientific’s application for TPT payment applicable to EXALT™ Model D Single-Use Duodenoscope. The new device TPT code (C1748) became effective July 1, 2020 and has been used successfully by hospitals to receive reimbursement up to the full cost of EXALT Model D when used to treat Medicare patients in the hospital outpatient setting.  This device specific payment is in addition to the endoscopic retrograde cholangiopancreatography (ERCP) procedure payment.   

If you would like more information on the new changes to the TPT payment calculation and how this impacts EXALT Model D, please contact us at ENDOFRM@bsci.com or 508-683-4510.

 
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