Revised May 2018

BIOTRONIKProduct and Medicare C-Code Cross Reference

biotronik.com

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Disclaimer

Reimbursement related information provided by BIOTRONIK is obtained from third party sources. This information is provided for the convenience of the health care provider only and does not constitute reimbursement, legal or compliance advice. Billing and coding information is subject to frequent and unexpected change, therefore BIOTRONIK recommends that users refer to the information sources listed to verify accuracy prior to acting on the information provided herein. BIOTRONIK makes no representation or warranty regarding this information or its accuracy, completeness or applicability and assumes no responsibility for updating this information. BIOTRONIK specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. BIOTRONIK strongly encourages health care providers to submit accurate and appropriate claims for services and recommends that you consult directly with payers (e.g. the Centers for Medicare and Medicaid Services (CMS)), certified reimbursement coding professionals, other reimbursement experts, and/or legal counsel regarding all coding, coverage, and payment issues.

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BIOTRONIK C-CODE Search Tool

SUMMARY/OVERVIEW:

• The Centers for Medicare and Medicaid Services (CMS) requires providers to report appropriate HCPCS Level II codes (C Codes) for all procedures considered “device-dependent.”

• C-Codes are required by CMS for the purpose of collecting accurate charge data for current procedures, and for setting future payment rates.

• Hospital bills that include device-related CPT procedure codes without the appropriate accompanying C code(s) describing the device(s) used in the procedure are subject to denial.

• This product cross reference includes a summary list of BIOTRONIK products. A comprehensive list of C-Codes is avalable at www.cms.gov/Medicare.

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Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

CIED PPM SC Edora ProMRI SR-T 407157 C1786 Pacemaker, single chamber, rate-responsive (implantable)

CIED PPM SC Eluna ProMRI SR-T 394971 C1786 Pacemaker, single chamber, rate-responsive (implantable)

CIED PPM SC Etrinsa SR-T 394936 C1786 Pacemaker, single chamber, rate-responsive (implantable)

CIED ICD DX Intica ProMRI DX 404633 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD DX Inventra ProMRI UHE DX 399436 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD DX Inventra UHE DX 399437 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD DX Itrevia DX 393037 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD DX Iperia ProMRI DX 393032 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED PPM DC Edora ProMRI DR-T 407145 C1785 Pacemaker, dual chamber, rate-responsive (implantable)

CIED PPM DC Eluna ProMRI DR-T 394969 C1785 Pacemaker, dual chamber, rate-responsive (implantable)

CIED PPM DC Etrinsa DR-T 394931 C1785 Pacemaker, dual chamber, rate-responsive (implantable)

CIED ICD DC Ilivia ProMRI DR-T DF4 404623 C1721 Cardioverter-defibrillator, dual chamber (implantable)

CIED ICD DC Itrevia DR-T DF-1 392412 C1721 Cardioverter-defibrillator, dual chamber (implantable)

CIED ICD DC Itrevia DR-T DF4 392426 C1721 Cardioverter-defibrillator, dual chamber (implantable)

CIED ICD DC Iperia ProMRI DR-T DF-1 392409 C1721 Cardioverter-defibrillator, dual chamber (implantable)

CIED ICD DC Iperia ProMRI DR-T DF4 392423 C1721 Cardioverter-defibrillator, dual chamber (implantable)

CIED CRTP Etrinsa HF-T 394919 C2621 Pacemaker, other than single or dual chamber (implantable)

CIED CRTP Edora HF-T QP 407137 C2621 Pacemaker, other than single or dual chamber (implantable)

CIED ICM BioMonitor 394119 C1764 Event recorder, cardiac (implantable)

CIED ICM BioMonitor 2 398493 C1764 Event recorder, cardiac (implantable)

CIED CRTD Ilivia ProMRI HF-T QP DF4 IS4 404621 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Intica ProMRI HF-T QP DF-1 IS4 404629 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Itrevia HF-T DF-1 393014 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Itrevia HF-T DF4 393016 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Itrevia HF-T QP DF4 IS4 401662 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Iperia HF-T DF-1 393007 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Iperia HF-T DF4 393009 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED CRTD Inventra ProMRI HF-T QP DF4 IS4 393012 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)

CIED ICD SC Ilivia ProMRI VR-T DF-1 404625 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD SC Ilivia ProMRI VR-T DF4 404626 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD SC Itrevia VR-T DF-1 393040 C1722 Cardioverter-defibrillator, single chamber (implantable)

CIED ICD SC Itrevia VR-T DF4 393041 C1722 Cardioverter-defibrillator, single chamber (implantable)

Lead LV Corox OTW 75-BP 354805 C1900 Lead, coronary venous

Lead LV Corox OTW 85-BP 354807 C1900 Lead, coronary venous

Lead LV Corox OTW-L 75-BP 368345 C1900 Lead, coronary venous

Lead LV Corox OTW-L 85-BP 368346 C1900 Lead, coronary venous

Lead LV Corox OTW-S 75-BP 355148 C1900 Lead, coronary venous

Lead LV Corox OTW-S 85-BP 355149 C1900 Lead, coronary venous

Lead LV Sentus ProMRI OTW QP L 75/49 408718 C1900 Lead, coronary venous

Lead LV Sentus ProMRI OTW QP L 85/49 408719 C1900 Lead, coronary venous

Lead LV Sentus ProMRI OTW QP S 75/49 406081 C1900 Lead, coronary venous

Lead LV Sentus ProMRI OTW QP S 85/49 406082 C1900 Lead, coronary venous

Lead LV Sentus OTW QP L-75 386835 C1900 Lead, coronary venous

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Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Lead LV Sentus OTW QP L-85 386836 C1900 Lead, coronary venous

Lead LV Sentus OTW QP S-75 400719 C1900 Lead, coronary venous

Lead LV Sentus OTW QP S-85 400720 C1900 Lead, coronary venous

Lead LV Myopore (Greatbatch) BP35 360882 C1900 Lead, coronary venous

Lead LV Myopore (Greatbatch) BP54 360883 C1900 Lead, coronary venous

Lead PM Selox JT 45 346369 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Selox JT 53 346368 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Selox ST 53 346366 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Selox ST 60 346367 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Setrox S 45 350973 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Setrox S 53 350974 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Setrox S 60 350975 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Solia S 45 377176 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Solia S 53 377177 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead PM Solia S 60 377179 C1898 Lead, pacemaker, other than transvenous VDD single pass

Lead ICD SC Plexa ProMRI® S 65 402266 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Plexa ProMRI® S 75 402267 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Protego S 60 379970 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Protego S 65 379969 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Protego S 75 379968 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Protego T 65 379967 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Linoxsmart S 60 375012 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Linoxsmart S 65 369818 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Linoxsmart S 75 369819 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead ICD SC Linoxsmart T 65 369820 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

LDS Accessory Selectra CS Lead Delivery System 358735 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Accessory Kit 375518 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Amplatz 6.0-45 375519 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Amplatz 6.0-55 375520 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra BIO2-45 375523 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra BIO2-55 375524 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Extended Hook-45 375527 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Extended Hook-55 375528 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Hook-45 375529 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Hook-55 375530 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra MPEP-45 375531 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra MPEP-55 375532 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra MPH-45 375533 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra MPH-55 375534 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Right-45 375535 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Right-55 375536 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Straight-45 375537 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra Straight-55 375521 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

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Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

LDS Accessory Selectra IC 50-65 375545 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra IC 50-75 375546 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra IC 90-65 375547 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Selectra IC 90-75 375548 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Streamer Polymer ES 363724 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Streamer Polymer ES-J 363725 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Streamer XT 363726 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Streamer XT-J 363727 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Galeo Hydro ES Guidewire 127452 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

LDS Accessory Corodyn P1 Venogram Balloon Catheter 336074 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-away

Lead ICD DC Plexa ProMRI® SD 65/18 402263 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Plexa ProMRI® DF-1 SD 65/18 414001 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Protego SD 60/16 399408 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Protego SD 65/18 399410 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Protego SD 75/18 399411 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Protego TD 65/16 359076 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart SD 60/16 359065 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart SD 65/16 359066 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart SD 65/18 359067 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart SD 75/18 359068 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart TD 65/16 359073 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead ICD DC Linoxsmart TD 65/18 359074 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)

Lead DX Plexa ProMRI® DF-1 S DX 65/15 414005 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead DX Plexa ProMRI® DF-2 S DX 65/17 414006 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead DX Linoxsmart S DX 65/15 365500 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead DX Linoxsmart S DX 65/17 365501 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)

Lead Introducer SafeSheath II SS

398339, 398340, 398343, 398346, 398347, 398348,

398349, 398350, 398353, 398355, 398356, 398357, 398358,

398359

C1892 Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away

Lead Introducer SafeSheath II CLS

398711, 398713, 398714, 398715, 398717, 398718,

398719, 398720, 398723, 398724, 398725, 398726, 398727

C1892 Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away

Transluminal Angioplasty Pantera Pro 1.25/6 393289 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.25/10 393291 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.25/15 393298 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.25/20 393305 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.5/6 393290 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.5/10 393292 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

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Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Transluminal Angioplasty Pantera Pro 1.5/15 393299 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 1.5/20 393306 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.0/10 393293 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.0/15 393300 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.0/20 393307 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.0/25 393312 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.0/30 393317 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.5/10 393294 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.5/15 393301 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.5/20 393308 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.5/25 393313 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 2.5/30 393318 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.0/10 393295 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.0/15 393302 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.0/20 393309 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.0/25 393314 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.0/30 393319 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.5/10 393296 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.5/15 393303 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.5/20 393310 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.5/25 393315 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 3.5/30 393320 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 4.0/10 393297 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 4.0/15 393304 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 4.0/20 393311 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 4.0/25 393316 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera Pro 4.0/30 393321 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.0/8 366991 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.25/8 366992 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.5/8 366993 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.75/8 366994 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.0/8 366995 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.25/8 366996 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.5/8 366997 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.75/8 366998 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.0/8 366999 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.5/8 367000 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 5.0/8 367001 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.0/12 367002 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.25/12 367003 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.5/12 367004 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.75/12 367005 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.0/12 367006 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

8

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Transluminal Angioplasty Pantera LEO 3.25/12 367007 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.5/12 367008 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.75/12 367009 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.0/12 367010 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.5/12 367011 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 5.0/12 367012 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.0/15 367013 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.25/15 367014 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.5/15 367015 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.75/15 367016 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.0/15 367017 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.25/15 367018 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.5/15 367019 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.75/15 367020 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.0/15 367021 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.5/15 367022 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 5.0/15 367023 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.0/20 367024 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.25/20 367025 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.5/20 367026 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.75/20 367027 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.0/20 367028 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.25/20 367029 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.5/20 367030 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.75/20 367031 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.0/20 367032 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.5/20 367033 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 5.0/20 367034 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.0/30 367035 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.25/30 367036 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.5/30 367037 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 2.75/30 367038 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.0/30 367039 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.25/30 367040 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.5/30 367041 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 3.75/30 367042 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.0/30 367043 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 4.5/30 367044 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Transluminal Angioplasty Pantera LEO 5.0/30 367045 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Guide Wire Galeo Pro 190 F 389783 C1769 Guide Wire

Guide Wire Galeo Pro 190 ES-F 389787 C1769 Guide Wire

Guide Wire Galeo Pro 190 HF 389781 C1769 Guide Wire

Guide Wire Galeo Pro 190 M 389785 C1769 Guide Wire

9

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Guide Wire Galeo Pro 190 F-J 389784 C1769 Guide Wire

Guide Wire Galeo Pro 190 M-J 389786 C1769 Guide Wire

Guide Wire Galeo Pro 190 ES-F-J 389788 C1769 Guide Wire

Guide Wire Galeo Pro 190 HF-J 389782 C1769 Guide Wire

Guide Wire Galeo Pro 300 F 389791 C1769 Guide Wire

Stent/Delivery System PRO-Kinetic Energy 2.25/9 383860 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.25/13 383867 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.25/15 383874 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.25/18 383881 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.25/20 383888 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/9 383861 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/13 383868 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/15 383875 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/18 383882 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/20 383889 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.5/22 383894 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/9 383862 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/13 383869 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/15 383876 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/18 383883 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/20 383890 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/22 383895 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/26 383899 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 2.75/30 383903 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/9 383863 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/13 383870 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/15 383877 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/18 383884 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/20 383891 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/22 383896 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/26 383900 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.0/30 383904 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/9 383864 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/13 383871 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/15 383878 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/18 383885 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/20 383892 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/22 383897 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/26 383901 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/30 383905 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 3.5/35 383907 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/9 383865 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/13 383872 C1876 Stent, noncoated/noncovered, with delivery system

10

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Stent/Delivery System PRO-Kinetic Energy 4.0/15 383879 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/18 383886 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/20 383893 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/22 383898 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/26 383902 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/30 383906 C1876 Stent, noncoated/noncovered, with delivery system

Stent/Delivery System PRO-Kinetic Energy 4.0/35 383908 C1876 Stent, noncoated/noncovered, with delivery system

Guidewire Cruiser-18 195cm Medium 357259 C1769 Guidewire

Guidewire Cruiser-18 195cm Stiff 357260 C1769 Guidewire

Guidewire Cruiser-18 300cm Medium 357261 C1769 Guidewire

Guidewire Cruiser-18 300cm Stiff 357262 C1769 Guidewire

Introducer Sheath Fortress 4F Crossover Introducer 358813 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 4F Straight - 45 358814 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 4F Straight - 100 358815 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 5F Crossover Introducer 386590 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 5F Straight - 45 386591 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 5F Straight - 100 386592 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 6F Crossover Introducer 386593 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 6F Straight - 45 386594 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Introducer Sheath Fortress 6F Straight - 100 386595 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser

Nitinol Self Expanding Stent - Iliac Astron 10x40x72 364657 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 10x60x72 364658 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 10x80x72 364659 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x30x130 364660 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x30x72 364645 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x40x130 364661 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x40x72 364646 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x60x130 364662 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x60x72 364647 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x80x130 364663 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 7x80x72 364648 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x30x130 364664 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x30x72 364649 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x40x130 364665 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x40x72 364650 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x60x130 364666 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x60x72 364651 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x80x130 364667 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 8x80x72 364652 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x30x130 364668 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x30x72 364653 C1876 Stent, non-coated/non-covered, with delivery system

11

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Nitinol Self Expanding Stent - Iliac Astron 9x40x130 364669 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x40x72 364654 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x60x130 364670 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x60x72 364655 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x80x130 364671 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - Iliac Astron 9x80x72 364656 C1876 Stent, non-coated/non-covered, with delivery system

PTA Peripheral Balloon Passeo-14 1.5x20x120 380271 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 1.5x20x150 380313 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 1.5x40x120 380277 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 1.5x40x150 380319 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 1.5x70x120 380283 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 1.5x70x150 380325 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x100x150 380333 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x100x90 380291 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x140x150 380339 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x140x90 380297 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x180x150 380345 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x180x90 380303 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x220x150 380351 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x220x90 380309 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x40x150 380321 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x40x90 380279 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x70x150 380327 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2.5x70x90 380285 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x100x120 380290 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x100x150 380332 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x140x120 380296 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x140x150 380338 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x180x120 380302 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x180x150 380344 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x220x120 380308 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x220x150 380350 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x40x120 380278 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x40x150 380320 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x70x120 380284 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 2x70x150 380326 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x100x150 380335 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x100x90 380293 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x140x150 380341 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x140x90 380299 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x40x150 380323 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x40x90 380281 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3.5x70x150 380329 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

12

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-14 3.5x70x90 380287 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x100x150 380334 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x100x90 380292 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x140x150 380340 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x140x90 380298 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x180x150 380346 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x180x90 380304 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x220x150 380352 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x220x90 380310 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x40x150 380322 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x40x90 380280 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x70x150 380328 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 3x70x90 380286 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x100x150 380336 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x100x90 380294 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x140x150 380342 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x140x90 380300 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x40x150 380324 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x40x90 380282 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x70x150 380330 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-14 4x70x90 380288 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x120x130 357507 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x120x90 357476 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x150x130 366130 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x150x90 366107 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x170x130 357512 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x170x90 357483 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x200x130 376297 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x200x90 376277 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x20x130 357486 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x20x90 357451 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x40x130 357491 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x40x90 357458 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x60x130 366120 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x60x90 366101 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x80x130 357502 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2.5x80x90 357469 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x120x150 366126 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x120x90 366105 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x150x150 366129 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x150x90 366106 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x170x150 366137 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

13

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-18 2x170x90 366114 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x200x150 376296 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x200x90 376276 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x20x150 366115 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x20x90 366098 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x40x150 366118 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x40x90 366099 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x60x150 366119 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x60x90 366100 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x80x150 366123 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 2x80x90 366104 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x120x130 357509 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x120x90 357478 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x150x130 366132 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x150x90 366109 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x170x130 357514 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x170x90 357485 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x200x130 376299 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x200x90 376279 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x20x130 357488 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x20x90 357453 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x40x130 357493 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x40x90 357460 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x60x130 366122 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x60x90 366103 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x80x130 357504 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3.5x80x90 357471 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x120x130 357508 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x120x90 357477 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x150x130 366131 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x150x90 366108 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x170x130 357513 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x170x90 357484 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x200x130 376298 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x200x90 376278 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x20x130 357487 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x20x90 357452 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x40x130 357492 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x40x90 357459 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x60x130 366121 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x60x90 366102 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x80x130 357503 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 3x80x90 357470 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

14

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-18 4x120x130 357510 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x120x90 357479 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x150x130 366133 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x150x90 366110 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x170x130 376292 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x170x90 376272 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x200x130 376300 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x200x90 376280 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x20x130 357489 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x20x90 357454 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x40x130 357494 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x40x90 357461 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x60x130 357498 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x60x90 357465 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x80x130 357505 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 4x80x90 357472 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x120x130 357511 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x120x90 357480 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x150x130 366134 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x150x90 366111 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x170x130 376293 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x170x90 376273 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x200x130 376301 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x200x90 376281 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x20x130 357490 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x20x90 357455 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x40x130 357495 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x40x90 357462 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x60x130 357499 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x60x90 357466 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x80x130 357506 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 5x80x90 357473 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x120x130 366127 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x120x90 357481 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x150x130 366135 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x150x90 366112 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x170x130 376294 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x170x90 376274 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x200x130 376302 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x200x90 376282 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x20x130 366116 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x20x90 357456 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x40x130 357496 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

15

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-18 6x40x90 357463 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x60x130 357500 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x60x90 357467 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x80x130 366124 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 6x80x90 357474 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x120x130 366128 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x120x90 357482 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x150x130 366136 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x150x90 366113 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x170x130 376295 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x170x90 376275 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x200x130 376303 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x200x90 376283 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x20x130 366117 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x20x90 357457 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x40x130 357497 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x40x90 357464 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x60x130 357501 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x60x90 357468 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x80x130 366125 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-18 7x80x90 357475 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x20x130 383261 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x20x80 357287 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x40x130 383263 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x40x80 357293 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x60x130 383267 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x60x90 383234 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x80x130 383271 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 10x80x90 383238 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x100x130 383272 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x100x90 383239 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x120x130 383276 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x120x90 383243 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x150x130 389777 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x150x90 389775 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x170x130 389778 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x170x90 389776 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x200x130 387163 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x200x90 387162 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x20x130 359549 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x20x80 359545 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x40x130 359551 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x40x80 359547 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

16

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-35 3x60x130 383264 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x60x90 383231 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x80x130 383268 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 3x80x90 383235 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x100x130 383273 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x100x90 383240 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x120x130 383277 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x120x90 383244 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x150x130 383281 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x150x90 383248 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x170x130 383285 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x170x90 383252 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x200x130 383289 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x200x90 383256 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x20x130 359550 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x20x80 359546 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x40x130 359552 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x40x80 359548 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x60x130 383265 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x60x90 383232 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x80x130 383269 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 4x80x90 383236 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x100x130 357322 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x100x80 357302 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x120x130 383278 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x120x90 383245 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x150x130 383282 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x150x90 383249 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x170x130 383286 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x170x90 383253 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x200x130 383290 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x200x90 383257 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x20x130 357306 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x20x80 357282 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x40x130 357310 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x40x80 357288 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x60x130 357314 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x60x80 357294 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x80x130 357318 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 5x80x80 357298 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x100x130 357323 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x100x80 357303 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x120x130 383279 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

17

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-35 6x120x90 383246 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x150x130 383283 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x150x90 383250 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x170x130 383287 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x170x90 383254 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x200x130 383291 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x200x90 383258 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x20x130 357307 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x20x80 357283 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x40x130 357311 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x40x80 357289 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x60x130 357315 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x60x80 357295 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x80x130 357319 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 6x80x80 357299 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x100x130 357324 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x100x80 357304 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x120x130 383280 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x120x90 383247 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x150x130 383284 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x150x90 383251 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x170x130 383288 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x170x90 383255 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x200x130 383292 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x200x90 383259 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x20x130 357308 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x20x80 357284 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x40x130 357312 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x40x80 357290 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x60x130 357316 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x60x80 357296 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x80x130 357320 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 7x80x80 357300 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x100x130 357325 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x100x80 357305 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x20x130 357309 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x20x80 357285 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x40x130 357313 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x40x80 357291 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x60x130 357317 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x60x80 357297 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x80x130 357321 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 8x80x80 357301 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

18

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral Balloon Passeo-35 9x20x130 383260 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x20x80 357286 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x40x130 383262 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x40x80 357292 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x60x130 383266 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x60x90 383233 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x80x130 383270 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral Balloon Passeo-35 9x80x90 383237 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 10x40x40 399075 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 10x40x75 399096 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 12x40x40 399076 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 12x40x75 399097 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 3x40x40 399056 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 3x40x75 399077 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 4x20x40 399057 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 4x20x75 399078 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 4x40x40 399058 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 4x40x75 399079 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x20x40 399059 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x20x75 399080 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x40x40 399060 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x40x75 399081 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x60x40 399061 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 5x60x75 399082 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x100x40 399065 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x100x75 399086 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x20x40 399062 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x20x75 399083 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x40x40 399063 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x40x75 399084 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x60x40 399064 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 6x60x75 399085 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x100x40 399069 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x100x75 399090 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x20x40 399066 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x20x75 399087 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x40x40 399067 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x40x75 399088 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x60x40 399068 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 7x60x75 399089 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x20x40 399070 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x20x75 399091 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x40x40 399071 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

19

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x40x75 399092 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x60x40 399072 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x60x75 399093 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x80x40 399073 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 8x80x75 399094 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 9x40x40 399074 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

PTA Peripheral High Pressure Balloon Passeo-35 HP 9x40x75 399095 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)

Nitinol Self Expanding Stent - SFA Pulsar-18 4/100/135 390707 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/100/90 390667 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/120/135 390708 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/120/90 390668 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/150/135 390709 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/150/90 390669 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/170/135 390710 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/170/90 390670 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/200/135 390711 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/200/90 390671 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/100/135 390717 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/100/90 390677 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/120/135 390718 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/120/90 390678 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/150/135 390719 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/150/90 390679 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/170/135 390720 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/170/90 390680 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/200/135 390721 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/200/90 390681 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/100/135 390727 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/100/90 390687 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/120/135 390728 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/120/90 390688 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/150/135 390729 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/150/90 390689 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/170/135 390730 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/170/90 390690 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/200/135 390731 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/200/90 390691 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/100/135 390737 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/100/90 390697 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/120/135 390738 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/120/90 390698 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/150/135 390739 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/150/90 390699 C1876 Stent, non-coated/non-covered, with delivery system

20

Device Category

Device Type

Device Name

Device Description

Model Number C Code HCPCS Level II Code Description

Nitinol Self Expanding Stent - SFA Pulsar-18 7/170/135 390740 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/170/90 390700 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/200/135 390741 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/200/90 390701 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/20/135 390702 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/20/90 390662 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/30/135 390703 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/30/90 390663 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/40/135 390704 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/40/90 390664 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/60/135 390705 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/60/90 390665 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/80/135 390706 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 4/80/90 390666 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/20/135 390712 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/20/90 390672 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/30/135 390713 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/30/90 390673 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/40/135 390714 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/40/90 390674 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/60/135 390715 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/60/90 390675 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/80/135 390716 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 5/80/90 390676 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/20/135 390722 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/20/90 390682 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/30/135 390723 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/30/90 390683 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/40/135 390724 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/40/90 390684 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/60/135 390725 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/60/90 390685 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/80/135 390726 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 6/80/90 390686 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/20/135 390732 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/20/90 390692 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/30/135 390733 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/30/90 390693 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/40/135 390734 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/40/90 390694 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/60/135 390735 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/60/90 390695 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/80/135 390736 C1876 Stent, non-coated/non-covered, with delivery system

Nitinol Self Expanding Stent - SFA Pulsar-18 7/80/90 390696 C1876 Stent, non-coated/non-covered, with delivery system

Disclaimer: Reimbursement related information provided by BIOTRONIK is obtained from third party sources. This information is provided for the convenience of the health care provider only and does not constitute reimbursement, legal or compliance advice. BIOTRONIK makes no representation or warranty regarding this information or its accuracy, completeness or applicability and assumes no responsibility for updating this information. BIOTRONIK specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. BIOTRONIK strongly encourages health care providers to submit accurate and appropriate claims for services and recommends that you consult directly with payers, certified reimbursement coding professionals, other reimbursement experts, and/or legal counsel regarding all coding, coverage, and payment issues.

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