CMS

Medicare reimbursement
EXALT™ Model D

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

 

Make sure your coding team has the correct coding and billing information to your facility receives adequate reimbursement for EXALT™ Model D Single-use Duodenoscope.

New Technology Add-on Payment (NTAP)

  • Medicare Hospital Inpatient NTAP: The Centers for Medicare & Medicaid Services (CMS) approved Boston Scientific’s application for NTAP applicable to EXALT Model D. NTAP is intended to facilitate Medicare patient access to new and innovative devices, like EXALT Model D, by providing eligible cases with additional device payment over and above the MS-DRG payment for a Medicare hospital inpatient admission. Effective October 1, 2021.
  • Inpatient ICD-10-PCS Procedure Codes: In response to our request, CMS created two unique ICD-10-PCS procedure codes for hospitals to facilitate reporting the use of single-use duodenoscopes, including EXALT Model D, in the hospital inpatient setting. Effective October 1, 2021.
    

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
    

Transitional Pass-through (TPT) Payment

CMS approved Boston Scientific’s application for TPT payment applicable to EXALT Model D on July 1, 2020. This device-specific payment is in addition to the endoscopic retrograde cholangiopancreatography (ERCP) procedure payment.

TPT Code: C1748 

TPT has been used successfully by hospitals to receive reimbursement up to the full cost of EXALT Model D when treating Medicare patients in the hospital outpatient setting. 

If you would like more information, please contact us at ENDOFRM@bsci.com or 508-683-4510.

 
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