REIMBURSEMENT ZOOM MEETING - CY 2021 MEDICARE HOSPITAL OUTPATIENT (OPPS) & PHYSICIAN (MPFS) UPDATES & CHANGES - Medtronic
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January 28, 2021 – Updated with OPPS/MPFS Final Rule and Updated Legislation
REIMBURSEMENT
ZOOM MEETING
CY 2021
MEDICARE HOSPITAL
OUTPATIENT (OPPS)
& PHYSICIAN (MPFS)
UPDATES & CHANGES
CARDIAC RHYTHM, HEART
FAILURE, ABLATION THERAPIES,
& DIAGNOSTICS
ECONOMICS, REIMBURSEMENT & EVIDENCE
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for
details
DISCLAIMER MEDTRONIC PROVIDES THIS INFORMATION FOR YOUR CONVENIENCE ONLY. IT DOES NOT CONSTITUTE LEGAL ADVICE OR A RECOMMENDATION REGARDING CLINICAL PRACTICE. INFORMATION PROVIDED IS GATHERED FROM THIRD-PARTY SOURCES AND IS SUBJECT TO CHANGE WITHOUT NOTICE DUE TO FREQUENTLY CHANGING LAWS, RULES AND REGULATIONS. THE PROVIDER HAS THE RESPONSIBILITY TO DETERMINE MEDICAL NECESSITY AND TO SUBMIT APPROPRIATE CODES AND CHARGES FOR CARE PROVIDED. MEDTRONIC MAKES NO GUARANTEE THAT THE USE OF THIS INFORMATION WILL PREVENT DIFFERENCES OF OPINION OR DISPUTES WITH MEDICARE OR OTHER PAYERS AS TO THE CORRECT FORM OF BILLING OR THE AMOUNT THAT WILL BE PAID TO PROVIDERS OF SERVICE. PLEASE CONTACT YOUR MEDICARE CONTRACTOR, OTHER PAYERS, REIMBURSEMENT SPECIALISTS AND/OR LEGAL COUNSEL FOR INTERPRETATION OF CODING, COVERAGE AND PAYMENT POLICIES. THIS DOCUMENT PROVIDES ASSISTANCE FOR FDA APPROVED OR CLEARED INDICATIONS. WHERE REIMBURSEMENT IS SOUGHT FOR USE OF A PRODUCT THAT MAY BE INCONSISTENT WITH, OR NOT EXPRESSLY SPECIFIED IN, THE FDA CLEARED OR APPROVED LABELING (E.G., INSTRUCTIONS FOR USE, OPERATOR’S MANUAL OR PACKAGE INSERT), CONSULT WITH YOUR BILLING ADVISORS OR PAYERS ON HANDLING SUCH BILLING ISSUES. SOME PAYERS MAY HAVE POLICIES THAT MAKE IT INAPPROPRIATE TO SUBMIT CLAIMS FOR SUCH ITEMS OR RELATED SERVICE. CPT® CODES AND DESCRIPTIONS ONLY ARE COPYRIGHT ©2020 AMERICAN MEDICAL ASSOCATION. ALL RIGHTS RESERVED. NO FEE SCHEDULES ARE INCLUDED IN CPT. THE AMERICAN MEDICAL ASSOCATION ASSUMES NO LIABILITY FOR DATA CONTAINED OR NOT CONTAINED HEREIN. Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
CY 2021 MEDICARE OUTPATIENT & PHYSICIAN FEE SCHEDULE UPDATES & CHANGES
AGENDA
• Presenters
Introductions • Therapies
• OPPS & ASC
New for CY 2021 • MPFS
• OPPS
Payment Rates • MPFS
• Cardiac Device Monitoring
Hot Topics & Reminders • Subcutaneous Cardiac Rhythm Monitoring
• Resources
Website information • Contacts
• Rate Appendix
Appendix • Resources
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
MEDTRONIC CARDIAC RHYTHM, HEART FAILURE, ABLATION THERAPIES, AND DIAGNOSTICS ECONOMICS, REIMBURSEMENT & EVIDENCE
MEET YOUR MEDTRONIC PRESENTERS
Senior Reimbursement Analyst Senior Reimbursement Analyst
Karissa Alm, CPC Annie Lundell
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
MEDTRONIC CARDIOVASCULAR GROUP
ELECTROPHYSIOLOGICAL THERAPY PORTFOLIO
Patient Pacemakers Defibrillators Mechanical Diagnostics Cardiac
Monitoring Circulatory Ablation
• Transvenous • CRT-D Support • LINQ™ ICM Solutions
• CareLink™ • Leadless • Implantable
network • CRT-P Cardioverter
• HeartWare • Cryoablation
• Connectivity and • Infection Defibrillators
HVAD™ System • CardioInsight™
Insights Control (TYRX™) (ICDs)
Technology
• Cardiac envelope • Infection
Compass Control (TYRX™)
envelope
• Heart Failure
Management
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
CY 2021 UPDATES FOR MEDTRONIC NEW NAME - AFS IS NOW CAS Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
CY 2021 UPDATES FOR MEDICARE OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS) AND AMBULATORY SURGERY CENTER (ASC) EXECUTIVE SUMMARY
CY 2021 MEDICARE OUTPATIENT UPDATES & CHANGES
CONVERSION FACTOR & RATES
Factor
Changes
OPPS Rate
Conversion
CY2021 OPPS conversion Approx. 1% increases for
factor of $82.797 for facilities implants
meeting the quality reporting
requirements
CAS & Diagnostics seeing
greater increases
CY2021 OPPS conversion • CAS approx. 5%
factor of $81.183 for facilities • Diagnostics approx. 7%
not meeting the quality
reporting requirements
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
CY 2021 MEDICARE OUTPATIENT UPDATES & CHANGES
ELIMINATION OF THE INPATIENT ONLY (IPO) LIST
BACKGROUND FINAL DECISION REMINDER
Established CY 2000 Effective CY 2021 Removal from the IPO list:
Created to identify services Phased elimination over 3 years 1. Does not ensure coverage
that require inpatient care due
to: Complete elimination by 2. Does not assume services
• Invasive nature of the CY 2024 can be rendered in an ASC
procedure setting
• Need for at least 24 hours of Begins with the removal of nearly
post-op care 300 musculoskeletal-related
• Underlying condition of the services
patient¹
¹85 Fed. Reg. 48,772, 48,908–909. Accessed January 8, 2021. https://www.govinfo.gov/content/pkg/FR-2020-08-12/pdf/2020-17086.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY2021 MEDICARE OUTPATIENT UPDATES & CHANGES
STATUS INDICATOR CHANGES
CY 2020
CPT® Code¹ Short Descriptor SI APC
33275 Transcatheter removal permanent T 5183
leadless pacemaker w/ imaging
CY 2021
CPT® Code¹ Short Descriptor SI APC
33275 Transcatheter removal permanent J1 5183
leadless pacemaker w/ imaging
T: Paid under OPPS, separate APC payment
J1: Paid under OPPS. Payment for all covered Part B services on the claim is packaged into a single payment for specific combinations of services,
except services with OPPS SI = F, G, H, L, and U; ambulance services; diagnostic screening mammography; all preventative services; and certain Part
B inpatient services
¹CPT codes and descriptions only are copyright ©2020 American Medical Association. All rights reserved. No fee schedules are included in CPT. The American Medical Association assumes no liability
for data contained or not contained herein.
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 MEDICARE ASC UPDATES & CHANGES
CONVERSION FACTOR & RATES
Factor
ASC Updates
Conversion
CY2021 ASC conversion factor No new CPT codes or descriptor
of $48.984 for facilities meeting revisions, no deletions
the quality reporting
requirements
CMS updated the ASC rates by
2.4%
CY2021 ASC conversion factor
of $48.029 for facilities not
meeting the quality reporting 11 new procedures added to the
requirements Approved Procedure List (none
of which apply to our therapies)
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 MEDICARE ASC UPDATES AND CHANGES
ASC STATUS INDICATOR CHANGE FOR 2021
CY 2020 CY 2021
CPT Description SI CPT Description SI
33234 Removal of transvenous G2 33234 Removal of transvenous J8
pacemaker electrode(s); pacemaker electrode(s);
single lead system, atrial or single lead system, atrial or
ventricular ventricular
33275 Transcatheter removal G2 33275 Transcatheter removal J8
permanent leadless permanent leadless
pacemaker w/ imaging pacemaker w/ imaging
G2: Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS
relative payment weight
J8: Device-intensive procedure; paid at adjusted rate
OPPS/ASC 2021 final rule CMS-1736-FC https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Status indicators. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS1392P_Addendum_D1.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 UPDATES FOR MEDICARE PHYSICIAN FEE SCHEDULE (MPFS) EXECUTIVE SUMMARY
CY 2021 UPDATE FOR MEDICARE PHYSICIAN FEE SCHEDULE
WHAT’S NEW?
Supervision of Diagnostic Tests by Certain NPPs
• Includes CRNAs in the group of specified NPPs
• Separately enumerated Medicare benefit category allowed to supervise
diagnostic tests
• Only applies to certain states where scope of practice and state law allows
Prolonged Office/Outpatient E/M Visits
• New times established for this code set
• New HCPCS Code G2212, instead of 99417
• Do not report G2212 on the same date of service as 99354, 99355, 99358,
99359, 99415, 99416
• Do not report G2212 for any time unit less than 15 minutes
2021 Medicare Physician Fee Schedule Final Rule (CMS-1734-F) https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 UPDATE FOR MEDICARE PHYSICIAN FEE SCHEDULE
RECENT UPDATES TO MPFS FINAL RULE
MPFS conversion factor for CY 2021 is 34.8931
• Final Rule: CF Decreased from 36.0896 in 2020 to 32.4085 in 2021
• New legislation: CF increased from 32.4085 to 34.8931
3.75% increase in MPFS payments for CY 2021
• Based on new legislation
Suspended the 2% payment adjustment (sequestration) through March 31, 2021
• Suspended May 1 – December 31, 2020 due to the Coronavirus Aid, Relief, and Economic Security
(CARES) Act
• Extended suspension period to March 31, 2021 in the Consolidated Appropriations Act of
2021 passed December 27, 2020
2021 Medicare Physician Fee Schedule Final Rule (CMS-1734-F) https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 UPDATE FOR MEDICARE PHYSICIAN FEE SCHEDULE
CY 2021 CONVERSION FACTOR
• Notable changes for MPFS
• Changes between Final Rule and December 27th legislation
• AMA and CMS recommended increase RVU’s for E&M codes
• Increase/decrease to cardiac rhythm, heart failure, ablation
therapies, and diagnostic services
Based on the
December 27th
legislation
Medicare Physician Reimbursement = CPT RVU x CF
CY 2021 RVU
CY 2021
CY 2021
Statutory Budget
CY 2020 CF: Neutrality Conversion
Update
$36.0896 Adjustment: Factor:
Factor: 0.0%
$32.4085
$34.8931
-10.2
2021 Medicare Physician Fee Schedule Final Rule (CMS-1734-F) https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 MEDICARE NATIONAL OPPS PAYMENT RATES
MEDICARE HOSPITAL OUTPATIENT RATE CHANGES
CY 2020 TO FY 2021 SUMMARY
This highlights the % change in payment for major CRHF and CAS procedures between the OPPS 2020 payment year and 2021 payment year. This is the
payment rate of all the major APC associated with the typical case for the procedures below. The following pages will walk you through APC-specific changes.
For information on which procedures will fall into these categories for purposes of this summary, please contact Medtronic Reimbursement Customer
Support team.
Leadless Pacemaker Pacemaker System
Implant – CRT-P Implant
Implant (C-APC 5224)
(C-APC 5194) Transvenous
(C-APC 5223) +1.6%
+0.8%
+1.5%
Subcutaneous
ICD & CRT-D Cardiac Ablation Cardiac Rhythm
Systems Implant Procedures Monitor
(C-APC 5232) (C-APC 5213) (C-APC 5222)
+1.7% +5.0% +6.7%
Hospital Outpatient Regulations and Notices. cms.gov. https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc Accessed December 3, 2020.
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Insertion Permanent Transvenous Pacemaker System
33206 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s); atrial
33207 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s);ventricular
33208 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s); atrial and ventricular
Upgrade a single Pacemaker to a dualPacemaker
33214 Upgrade of implanted pacemaker system, conversion of single chamber system to J1 5223 $10,252 5223 $10,400 $148 1.44%
dual chamber system (includes removal of previously placed pulse generator, testing
of existing lead, insertion of new lead, insertion of new pulsegenerator)
Leadless Permanent PacemakerProcedures
33274 Transcatheter insertion or replacement of permanent leadless pacemaker, right J1 5194 $15,940 5194 $16,064 $124 0.78%
ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound,
ventriculography, femoral venography) and device evaluation (eg, interrogation or
programming), when performed
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 MEDICARE NATIONAL PHYSICIAN PAYMENT RATES
MEDICARE PHYSICIAN FEE SCHEDULE RATE CHANGES
CY 2020 TO CY 2021
This highlights the % change in payment for our cardiac therapy procedures between for the Medicare Physician Fee Schedule 2020 payment year
and 2021 payment year. For information on which procedures will fall into these categories for purposes of this summary, please contact Medtronic
Reimbursement Customer Support team. The rates below reflect an average decrease across the CPT’s within that therapy (for insertion/implantation).
Leadless Pacemakers &
LVAD
Pacemaker CRT-P
-3.07% (avg) -2.86% (avg)
-3.15% (avg)
Subcutaneous
ICD & CRT-D Cardiac Ablation Cardiac Rhythm
Systems Procedures Monitor
-3.4% (avg) -2.85% (avg) -3.23%
PFS final rule page https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE PHYSICIAN FEE SCHEDULE 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Insertion Permanent Transvenous Pacemaker System
33206 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $476 $468 -1.68%
with transvenous electrode(s);atrial
33207 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $502 $492 -1.99%
with transvenous electrode(s);ventricular
33208 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $546 $534 -2.20%
with transvenous electrode(s); atrial and ventricular
Leadless Permanent Pacemaker Procedures
33274 Transcatheter insertion or replacement of permanent leadless N/A N/A N/A $510 $497 -2.55%
pacemaker, right ventricular, including imaging guidance (eg,
fluoroscopy, venous ultrasound, ventriculography, femoral
venography) and device evaluation (eg, interrogation or
programming), when performed
33275 Transcatheter removal of permanent leadless pacemaker, right N/A N/A N/A $558 $538 -3.58%
ventricular, including imaging guidance (eg. Fluoroscopy, venous
ultrasound, ventriculography, femoral ventriculography), when
performed
PFS final rule page https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsHOT TOPICS & REMINDERS
PACEMAKERS & ICDS
CY2021 HOT TOPICS & REMINDERS
MICRA TRANSCATHETER LEADLESS PACEMAKER
Medicare Only - Transmittal 3815
Medicare claims in a qualified clinical trial require additional codes and modifiers1
NCT03039712 (Model # MC1VR01)
National Clinical Trial (NCT) Identifier Number
NCT04235491 (Model # MC1AVR1)
Z00.6 – Encounter for examination for normal comparison and control in clinical
Diagnosis Code research program
(While CMS regulation allows for the Z00.6 to be coded in the primary (principal) or secondary position,
FDA labeled indications are generally most appropriately listed as a primary (principal) diagnosis.)
Modifier Q0 (zero) – Participation in a qualifying registry or qualified clinical study
(outpatient hospital and physician claims only)
Condition Code 30 - Qualified Clinical Trial (Include on facility claims only)
POS 06: Indian Health Service Provider Based Facility
POS 21: Inpatient Hospital
Covered Place of Service POS 22: On Campus – Outpatient Hospital
POS 26: Military Treatment Facility
POS 11: Office (only for device evaluations)
Please note that additional requirements may be in place. Please review the claims processing manual for additional details and requirements that may be applicable.
CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS)
Transmittal 3815. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3815CP.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 HOT TOPICS - ICD COVERAGE
SHARED DECISION MAKING-ICD
Physician Specialty Society Guidelines
A commonly accepted definition for shared decision making includes four
(4) components:
At least two participants — the clinician and the patient — are
involved
Both parties share information
Both parties take steps to build a consensus about the
preferred treatment
An agreement is reached on the treatment to implement
Sharing a decision does not mean giving a patient a list of risks and benefits
and telling them to make a decision (sometimes referred to as
‘abandonment’).
Al-Khatib SM, Stevenson WG, Ackerman MJ et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of
Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2017 Oct 30. pii: S1547-5271(17)31249-3
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 HOT TOPICS - ICD COVERAGE
SHARED DECISION MAKING-ICD (CON’T)
Primary prevention:
Formal shared decision-making encounter must:
Occur between the patient and a physician or qualified non-physician
practitioner (physician assistant, nurse practitioner, or clinical nurse
specialist)
Use an evidence-based decision tool on ICDs prior to initial ICD
implantation.
Encounter can happen during a separate visit.
Shared Decision-Making Tools:
https://patientdecisionaid.org/icd/.
https://www.cardiosmart.org/healthwise/abk4/103/abk4103.
In addition, guidelines published in 2017 by AHA/ACC/HRS provide
recommendations for the elements of shared decision making.
Al-Khatib SM, Stevenson WG, Ackerman MJ et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of
Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2017 Oct 30. pii: S1547-5271(17)31249-3
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCARDIAC DEVICE MONITORING
CY 2021 HOT TOPICS - DEVICE MONITORING
IMPLANTABLE CARDIOVASCULAR MONITORS (ICM)
Code G2066 remains in effect for CY2021 to • Beginning on date of service January
report the technical component of ICM 1, 2020, HCPCS code G2066 should
be reported for remote ICM technical
monitoring services
Code Descriptor • No change for reporting remote ICM
CPT® Interrogation device evaluation(s), (remote) up to 30 days; professional services
Professional
Component
93298 subcutaneous cardiac rhythm monitor system, including analysis
of recorded heart rhythm data, analysis, review(s), and report(s) by • No change for reporting ICM insertion,
a physician or other qualified health care professional explant, or in-person
monitoring/programming services
HCPCS Interrogation device evaluation(s), (remote) up to 30 days;
G2066 implantable cardiovascular physiologic monitor system , • Check with your commercial payers
Component
before reporting code G2066 as some
Technical
implantable loop recorder system, or subcutaneous cardiac
rhythm monitor system, remote data acquisition(s), receipt of commercial payers may have different
transmissions and technician review, technical support and coding recommendations for this
distribution of results
service
PFS Federal Regulation Notices. cms.gov https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-
Federal-Regulation-Notices.html Updated November 1, 2019. Retrieved November 1, 2019
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 HOT TOPICS - CARDIAC DEVICE MONITORING DEFINITIONS
WHAT IS DEVICE MONITORING?
PROGRAMMING DEVICE EVALUATION – IN PERSON
Iterative adjustments made to parameters and evaluated.
Final parameters may be same as original
Always includes interrogation and (temporary) reprogramming
REMOTE MONITORING
Defined time periods:
30-day monitoring period, do not report if monitoring period is less than 10 days.
90-day monitoring period, do not report if monitoring period is less than 30.
Monitoring period starts with the first monitoring service, continues through 30
or 90 days
New time period begins on the 31st or 91st day
• Contact your MAC/payer for additional information.
• American Medical Association. 2020 CPT Professional Edition. Details may be found in the Cardiovascular monitoring section.
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 HOT TOPICS - CARDIAC DEVICE MONITORING PROCEDURES
PROGRAMMING VS. INTERROGATION?
CPT INTRODUCTORY TEXT CLARIFICATION ON COMPONENTS BY DEVICE TYPE
The specific components for each interrogation and programming for each cardiac device type are outlined in the
“implantable, insertable, and wearable cardiac device evaluation” section of the 2021 CPT Professional Edition book. See
this definitive source for more details. Highlights include:
Parameters that must be Checked During Interrogation
Programmed parameters and the heart rate and rhythm during recorded episodes from both patient-initiated and device
algorithm detected events, when present
Programming Differentiation
All components of Interrogation plus:
Iterative adjustments of the programmable parameters are conducted
Iterative adjustments provide information that permits the operator to assess and select the most appropriate final
program parameters to:
Provide for consistent delivery of the appropriate therapy; and
Verify function of the device
Final program parameters may or may not change after evaluation
Often, but not always, the tachycardia and bradycardia detection criteria will be adjusted (this is specific to subcutaneous
cardiac rhythm monitors)
Source: AMA CPT Professional Edition Codebook 2020.
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsCY 2021 HOT TOPICS - CARDIAC DEVICE MONITORING
DATE OF SERVICE
What date do you report monitoring for a timeframe?
• CMS has published guidance on the appropriate date of service to be
used on professional claims when reporting cardiac monitoring.
• The guidance states that the date of service reported for cardiac
monitoring is based on the code description and time listed.
• In situations where the code describes the professional service, CMS
states “the date of service is the date the physician completes that
activity.”
• In situations where the code describes the technical service, CMS
states “ the date of service is the date the monitoring concludes based
on the description of the service.”
• See CMS guidance on coding and billing date of service on professional
claims (SE17023) for more details
Centers for Medicare and Medicaid Services. MLN Matters Article SE17023 (Revised) Released February 1, 2019. Available at:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17023.pdf.
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsSUBCUTANEOUS CARDIAC RHYTHM MONITOR
CY 2021 HOT TOPICS - SUBCUTANEOUS CARDIAC RHYTHM MONITOR
NON-PHYSICIAN PRACTITIONERS (NPP)
Q: What is an NPP? Examples of non-physician practitioners are nurse practitioners and physician assistants.
Q: Are NPPs permitted to perform LINQ insert/removal procedures?
The CPT coding and subsequent global period changes open the door for non-physician practitioners (NPPs) to perform
these procedures
There are several considerations (below) to be investigated and addressed by each individual account before an NPP
performs these procedures
Q: How are NPPs paid?
NPPs are paid at 85% of the physician rate in all places of service when billing independently.
Under specific criteria, the procedure can be billed “incident to” the physician to receive the full 100% physician
payment rate
CAUTION! The requirements for “incident to” billing are complex and vary by payer, both Medicare MACs and private payer
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsReference: https://www.cms.gov/files/document/ab-jurisdiction-map-dec-2020.pdf Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for details
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ADDITIONAL REIMBURSEMENT RESOURCES www.medtronic.com/crhfreimbursement
Contact the Reimbursement
Customer Support Team
By email:
rs.healthcareeconomics@medtronic.com
By phone:
866-877-4102
(M-F, 8 am CT–5 pm CT)
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsC-CODE FINDER
Find C-Codes by:
• Product Name
• Model Number
www.Medtronic.com/crhfcodes
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsREIMBURSEMENT WEBSITE
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CY 2021 MEDICARE OUTPATIENT & PHYSICIAN FEE SCHEDULE UPDATES & CHANGES
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Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsREFERENCES
FY2021 MEDICARE HOSPITAL OUTPATIENT & MPFS UPDATES & CHANGES
REFERENCES
CPT Reference:
CPT codes and descriptions only are copyright ©2020 American Medical Association. All rights reserved. No fee schedules are included in CPT. The American Medical Association
assumes no liability for data contained or not contained herein.
Source: National Coverage Determination (NCD) for Implantable Cardioverter Defibrillators (20.4) https://www.cms.gov/medicare-coverage-
database/details/ncd-details.aspx?NCDId=110&ncdver=4&bc=AAAAQAAAAAAA&
OPPS Rate Reference:
The OPPS 2021 National payment rates based on information published in the OPPS/ASC final rule CMS-1736-FC and corresponding Addendum B table which was published on
December 3, 2020.
Hospital Outpatient Regulations and Notices. cms.gov. https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-
and-notices/cms-1736-fc Accessed December 3, 2020.
Hospital specific rates will vary based on various hospital-specific factors not reflected in this document and CMS may make adjustments to any or all of the data inputs from time
to time.
MPFS Rate Reference:
The Medicare Physician Fee Schedule (MPFS) 2021 National payment rates based on information published in the MPFS final rule CMS-1734-F and corresponding tables, updated
due to legislation that was signed December 27, 2020 including corresponding tables which were updated on December 29,2020. PFS Federal Regulation Notices. cms.gov
https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f Accessed December 3, 2020.
Local physician rates will vary based on location specific factors not reflected in this document. CMS may make adjustments to any or all of the data inputs from time to time.
Centers for Medicare and Medicaid Services. Hospital Outpatient Regulations and Notices. cms.gov https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/HospitalOutpatientPPS/Hospital- Outpatient-Regulations-and-Notices.html Accessed January 6, 2020.
Hospital specific rates will vary based on various hospital-specific factors not reflected in this document and CMS may make adjustments to any or all of the data inputs
from time to time
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsFY2021 MEDICARE HOSPITAL OUTPATIENT & MPFS UPDATES & CHANGES
REFERENCES
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Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsAPPENDIX
FY2021 MEDICARE OUTPATIENT FEE SCHEDULE UPDATES & CHANGES
STATUS INDICATOR REFRESHER
Status Indicator and Item/Code/Service OPPS Payment Status
C: Inpatient Procedures Not paid under OPPS. Admit patient. Bill as inpatient.
H: Pass-Through Device Categories Separate cost-based pass through payment; not subject to copayment.
J1: Hospital Part B services paid through a Paid under OPPS. Payment for all covered Part B services on the claim is packaged into a
comprehensive APC single payment for specific combinations of services, except services with OPPS SI = F, G, H,
L and U; ambulance services; diagnostic and screening mammography; all preventative
services; and certain Part B inpatient services.
J2: Hospital Part B Services That May Be Paid Paid under OPPS; Addendum B displays APC assignments when services are separately
Through a Comprehensive APC payable
(1) Comprehensive APC payment based on OPPS comprehensive-specific payment criteria.
Payment for all covered Part B services on the claim is packaged into a single payment for
specific combinations of services, except services with OPPS SI = F, G, H, L and U; ambulance
services; diagnostic and screening mammography; all preventative services; and certain Part
B inpatient services.
(2) Packaged APC payment if billed on the same claim as a HCPCS code assigned status
indicator “J1.”
(3) In other circumstances, payment is made through a separate APC payment or packaged
into payment for other services.
Reference: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS1392P_Addendum_D1.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsFY2021 MEDICARE OUTPATIENT FEE SCHEDULE UPDATES & CHANGES
STATUS INDICATOR REFRESHER
Status Indicator and Item/Code/Service OPPS Payment Status
N: Items and Services Packaged into APC Paid under OPPS; payment is packaged into payment for other services. Therefore, there is
Rates no separate APC payment.
Q1: S, T, V – Packaged Codes Paid under OPPS; Addendum B displays APC assignments when services are separately
payable.
(1) Packaged APC payment if billed on the same claim as a HCPCS code assigned status
indicator “S,” “T,” or “V.”
(2) Composite APC payment if billed with specific combinations of services based on OPPS
composite-specific payment criteria. Payment is packaged into a single payment for specific
combinations of services.
(3) In other circumstances, payment is made through a separate APC payment.
Q2: T – Packaged Codes Paid under OPPS; Addendum B displays APC assignments when services are separately
payable.
(1) Packaged APC payment if billed on the same claim as a HCPCS code assigned status
indicator “T.”
(2) In other circumstances, payment is made through a separate APC payment.
S: Procedure or Service, Not Discounted Paid under OPPS; separate APC payment.
When Multiple
T: Procedure or Service, Multiple Procedure Paid under OPPS; separate APC payment.
Reduction Applies
Reference: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS1392P_Addendum_D1.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsFY2021 MEDICARE ASC FEE SCHEDULE UPDATES & CHANGES
STATUS INDICATOR REFRESHER
Status Indicator and Item/Code/Service OPPS Payment Status
G2 Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS
relative payment weight
J8 Device-intensive procedure; paid at adjusted rate
A2 Surgical procedure on ASC llist in CY 2007; payment based on OPPS relative payment weight
N1 Packaged service/item; no separate payment made
Reference: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS1392P_Addendum_D1.pdf
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsRATE APPENDIX
MEDICARE OPPS RATES FOR CARDIAC RHYTHM, HEART FAILURE, ABLATION THERAPIES, & DIAGNOSTICS (REMINDER: RATES BASED ON FINAL RULE)
MEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Insertion Permanent Transvenous Pacemaker System
33206 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s); atrial
33207 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s);ventricular
33208 Insertion of new or replacement of permanent pacemaker with transvenous J1 5223 $10,252 5223 $10,400 $148 1.44%
electrode(s); atrial and ventricular
Upgrade a single Pacemaker to a dualPacemaker
33214 Upgrade of implanted pacemaker system, conversion of single chamber system to J1 5223 $10,252 5223 $10,400 $148 1.44%
dual chamber system (includes removal of previously placed pulse generator, testing
of existing lead, insertion of new lead, insertion of new pulsegenerator)
Leadless Permanent PacemakerProcedures
33274 Transcatheter insertion or replacement of permanent leadless pacemaker, right J1 5194 $15,940 5194 $16,064 $124 0.78%
ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound,
ventriculography, femoral venography) and device evaluation (eg, interrogation or
programming), when performed
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES (CONTINUED)
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Pacemaker Generator Changeouts
33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker J1 5222 $7,642 5222 $8,153 $511 6.69%
pulse generator; single leadsystem
33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker J1 5223 $10,252 5223 $10,400 $148 1.44%
pulse generator; dual lead system
33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker J1 5224 $18,313 5224 $18,611 $298 1.63%
pulse generator; multiple lead system
Removal of Permanent Pacemaker Generator Only
33233 Removal of permanent pacemaker pulse generatoronly Q2 5222 $7,642 5222 $8,153 $511 6.69%
Leadless Permanent Pacemaker Procedures
33275 Transcatheter removal of permanent leadless pacemaker, right ventricular, including J1 5183 $2,771 5183 $2,862 $91 3.28%
imaging guidance (eg. fluoroscopy, venous ultrasound, ventriculography, femoral
ventriculography), when performed
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Insertion of permanent transvenous DefibrillatorSystem
33249 Insertion or replacement of permanent implantable defibrillator system, with J1 5232 $32,283 5232 $32,839 $556 1.72%
transvenous lead(s), single or dual chamber
Insertion Defibrillator Generator Only
33230 Insertion of implantable defibrillator pulse generator only; with existing dual leads J1 5231 $22,713 5231 $23,040 $327 1.44%
33231 Insertion of implantable defibrillator pulse generator only; with existing multiple leads J1 5232 $32,283 5232 $32,839 $556 1.72%
33240 Insertion of implantable defibrillator pulse generator only; with existing singlelead J1 5231 $22,713 5231 $23,040 $327 1.44%
Removal Defibrillator Generator Only
33241 Removal of implantable defibrillator pulse generatoronly Q2 5221 $2,984 5221 $3,440 $456 15.28%
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PROCEDURES (CONTINUED)
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Defibrillator Generator changeouts
33262 Removal of implantable defibrillator pulse generator with replacement of implantable J1 5231 $22,713 5231 $23,040 $327 1.44%
defibrillator pulse generator; single lead system
33263 Removal of implantable defibrillator pulse generator with replacement of implantable J1 5231 $22,713 5231 $23,040 $327 1.44%
defibrillator pulse generator; dual lead system
33264 Removal of implantable defibrillator pulse generator with replacement of implantable J1 5232 $32,283 5232 $32,839 $556 1.72%
defibrillator pulse generator; multiple lead system
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT CRT PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
CRT-PInsertion
33208 Insertion/replacement of permanent pacemaker with transvenous electrodes(s); J1 5224 $18,313 5224 $18,611 $298 1.63%
atrial and ventricular (Dual Chamber System)
+33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at
time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for
upgrade to dual chamber system) (List separately in addition to code for primary
procedure)
CRT-DInsertion
33249 Insertion or replacement of permanent implantable defibrillator system, with J1 5232 $32,283 5232 $32,839 $556 1.72%
transvenous lead(s), single or dual chamber
+33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at
time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for
upgrade to dual chamber system) (List separately in addition to code for primary
procedure)
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT SUBCUTANEOUS CARDIAC RHYTHM MONITOR PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Subcutaneous Cardiac Rhythm Monitor Procedures (incudes Loop Recorders)
33285 Insertion, subcutaneous cardiac rhythm monitor, including programming J1 5222 $7,642 5222 $8,153 $511 6.69%
33286 Removal, subcutaneous cardiac rhythm monitor Q2 5071 $610 5071 $622 $12 1.97%
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL OUTPATIENT 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT CARDIAC ABLATION PROCEDURES
® ®
CPT CPT Description 2021 Final Final 2020 Final Final 2021 $ %
Code SI 2020 OPPS 2021 OPPS Change Change
APC Payment APC Payment
Cardiac Ablation Procedures
93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, J1 5213 $20,435 5213 $21,464 $1,029 5.04%
insertion and repositioning of multiple electrode catheters with induction or
attempted induction of an arrhythmia including left or right atrial pacing/recording
when necessary, right ventricular pacing/recording when necessary, and His bundle
recording when necessary with intracardiac catheter ablation of atrial fibrillation by
pulmonary vein isolation
+93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct N - $- - $- $- N/A
from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat
a spontaneous or induced arrhythmia (List separately in addition to code for primary
procedure)
Additional linear or focal intracardiac catheter ablation of the left or right atrium for N - $- - $- $- N/A
+93657 treatment of atrial fibrillation remaining after completion of pulmonary vein isolation
(List separately in addition to code for primary procedure)
OPPS/ASC Final rule page https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1736-fc
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE MPFS RATES FOR CARDIAC RHYTHM, HEART FAILURE, ABLATION THERAPIES, & DIAGNOSTICS (REMINDER: RATES BASED ON CONSOLIDATED APPROPRIATIONS ACT OF 2021)
MEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Insertion Permanent Transvenous Pacemaker System
33206 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $476 $468 -1.68%
with transvenous electrode(s);atrial
33207 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $502 $492 -1.99%
with transvenous electrode(s);ventricular
33208 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $546 $534 -2.20%
with transvenous electrode(s); atrial and ventricular
Leadless Permanent Pacemaker Procedures
33274 Transcatheter insertion or replacement of permanent leadless N/A N/A N/A $510 $497 -2.55%
pacemaker, right ventricular, including imaging guidance (eg,
fluoroscopy, venous ultrasound, ventriculography, femoral
venography) and device evaluation (eg, interrogation or
programming), when performed
33275 Transcatheter removal of permanent leadless pacemaker, right N/A N/A N/A $558 $538 -3.58%
ventricular, including imaging guidance (eg. Fluoroscopy, venous
ultrasound, ventriculography, femoral ventriculography), when
performed
PFS final rule page https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT PACEMAKER PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Removal Permanent Transvenous Pacemaker System
33227 Removal of permanent peacemaker pulse generator with N/A N/A N/A $354 $348 -1.69%
replacement of pacemaker pulse generator; single lead
system
33228 Removal of permanent pacemaker pulse generator with N/A N/A N/A $371 $365 -1.62%
replacement of pacemaker pulse generator; dual lead
system
33229 Removal of permanent pacemaker pulse generator with N/A N/A N/A $392 $386 -1.53%
replacement of pacemaker pulse generator; multiple lead system
PFS 2021 Final Rule CMS-1734-F and updated legislation https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Insertion of Permanent Transvenous Defibrillator System
33249 Insertion or replacement of permanent implantable N/A N/A N/A $961 $942 -1.98%
defibrillator system, with transvenous lead(s), single or
dual chamber
Insertion Defibrillator Generator Only
33230 Insertion of implantable defibrillator pulse generator only; N/A N/A N/A $400 $394 -1.50%
with existing dual leads
33231 Insertion of implantable defibrillator pulse generator only; N/A N/A N/A $421 $412 -2.14%
with existing multiple leads
33240 Insertion of implantable defibrillator pulse generator only; N/A N/A N/A $382 $375 -1.83%
with existing single lead
PFS 2021 Final Rule CMS-1734-F and updated legislation https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Defibrillator Generator Change Outs
33262 Removal of implantable defibrillator pulse generator with N/A N/A N/A $391 $384 -1.79%
replacement of implantable defibrillator pulse generator; single
lead system
33263 Removal of implantable defibrillator pulse generator with N/A N/A N/A $406 $400 -1.48%
replacement of implantable defibrillator pulse generator; dual
lead system
33264 Removal of implantable defibrillator pulse generator with N/A N/A N/A $425 $417 -1.88%
replacement of implantable defibrillator pulse generator;
multiple lead system
PFS 2021 Final Rule CMS-1734-F and updated legislation https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT CRT PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Insertion CRT-P System
33207 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $502 $492 -1.99%
with transvenous electrode(s);atrial
+33225 Insertion of pacing electrode, cardiac venous system, for N/A N/A N/A $493 $479 -2.84%
left ventricular pacing, at time of insertion defibrillator or
pacemaker pulse generator (eg, for upgrade to dual
chamber system) (List separately in addition to code for
primary procedure)
33208 Insertion of new or replacement of permanent pacemaker N/A N/A N/A $546 $534 -2.20%
with transvenous electrode(s); atrial and ventricular
+33225 Insertion of pacing electrode, cardiac venous system, for N/A N/A N/A $493 $479 -2.84%
left ventricular pacing, at time of insertion defibrillator or
pacemaker pulse generator (eg, for upgrade to dual
chamber system) (List separately in addition to code for
primary procedure)
PFS 2021 Final Rule CMS-1734-F and updated legislation https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsMEDICARE HOSPITAL MPFS 2020 VS 2021 NATIONAL AVERAGE PAYMENT
SELECT CRT PROCEDURES
PHYSICIAN PAYMENT
NON-FACILITY FACILITY
® ®
CPT CPT Description Modifier 2020 2021 % 2020 2021 %
Code Total NF Total NF Change Total Total Change
Payment Payment Facility Facility
Payment Payment
Insertion Permanent Transvenous Defibrillator System
33249 Insertion or replacement of permanent implantable N/A N/A N/A $961 $942 -1.98%
defibrillator system, with transvenous lead(s), single or
dual chamber
+33225 Insertion of pacing electrode, cardiac venous system, for N/A N/A N/A $493 $479 -2.84%
left ventricular pacing, at time of insertion defibrillator or
pacemaker pulse generator (eg, for upgrade to dual
chamber system) (List separately in addition to code for
primary procedure)
PFS 2021 Final Rule CMS-1734-F and updated legislation https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Medtronic Economics, Reimbursement, & Evidence | CY 2021 Medicare OPPS & MPFS Update | January 2021 | For information only, see disclaimer for detailsYou can also read
