Updated April 2019

CATHETER ABLATION CODING & REIMBURSEMENT GUIDE

April 20192 of 8

TABLE OF CONTENTSDiagnosis Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ICD-10-CM Diagnosis Codes

Coverage for Catheter Ablation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4MedicareOther Payers

Physician Services Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6Catheter AblationDiagnostic Electrophysiologic Study (EPS)Moderate Sedation

Inpatient Hospital Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6ICD-10-PCS Procedure CodesMedicare Severity Diagnosis Related Group (MS-DRG) Assignments

Outpatient Hospital Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,8Comprehensive Ambulatory Payment Classification (C-APCs)Medicare Hospital Outpatient Catheter Ablation C-Code Listing

Frequently Asked Reimbursement Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

For questions or for more information, please contact the Medtronic Cardiac Rhythm & Heart Failure Reimbursement Services at 1-866-877-4102, Monday-Friday from 8:00 a.m. to 5:00 p.m. CT or by email at rs.healthcareeconomics@medtronic.com.

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules, and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists, and/or legal counsel for interpretation of coding, coverage, and payment policies. This document provides assistance for FDA-approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA-cleared or approved labeling (e.g., instructions for use, operator’s manual, or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

DIAGNOSIS CODESICD-10-CM1 Diagnosis Codes that May Support Ablation ProceduresThe following is a list of diagnosis codes that may be associated with VT, SVT, and PVI ablation procedures . The list is for illustrative purposes only .

Refer to the Instructions for Use supplied with a product for indications, contraindications, side effects, warnings, and precautions.

ICD-10-CM1 Diagnosis Code ICD-10-CM1 Diagnosis Code Description

I47.0 Re-entry ventricular arrhythmia

I47.1 Supraventricular tachycardia (includes AVNRT)

I47.2 Ventricular tachycardia

I47.9 Paroxysmal tachycardia, unspecified

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter (type I)

I48.4 Atypical atrial flutter (type II)

I49.01 Ventricular fibrillation

I49.02 Ventricular flutter

I49.1 Atrial premature depolarization (premature atrial beats and contractions)

I49.2 Junctional premature depolarization

I49.3 Ventricular premature depolarization (premature ventricular contractions)

I49.40 Unspecified premature depolarization (unspecified premature beats)

I49.49 Other premature depolarization (includes ectopic beats)

I49.5 Sick sinus syndrome (tachycardia-bradycardia syndrome)

I49.8 Other specified cardiac arrhythmias

I49.9 Cardiac arrhythmia, unspecified

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter

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COVERAGE FOR CATHETER ABLATION PROCEDURES MedicareMedicare has not issued national or local coverage determinations for catheter ablation services. The Social Security Act allows coverage and payment for only those services that are considered to be medically reasonable and necessary.2 The medical necessity for services provided must be documented in the medical record.

Other PayersWe recommend contacting the patient’s insurance company for guidance on what specific codes are required for catheter ablation procedures as part of a request for a prior authorization or a predetermination for the planned services.

PHYSICIAN SERVICES CODINGBoth the catheter ablation and electrophysiologic study (EPS) aspects of the procedure are reflected in catheter ablation codes. In some instances, the catheter ablation and EPS procedures are not considered distinct procedures and are therefore not reportable using separate codes.

This document reflects commonly billed codes for the catheter ablation and EPS procedures and their associated 2019 Medicare national reimbursement rates. This is not an all-inclusive list.

The following information reflects the Medicare national allowable amount published by CMS and does not include Medicare payment reductions resulting from sequestration adjustments to the amount payable to the provider, as mandated by the Budget Control Act of 2011. The Medtronic Healthcare Economics and Reimbursement team can provide site-specific information reflective of sequestration upon request.

Catheter Ablation

CPT®3 Code CPT3 Code Description

2019 Medicare National Physician Rate4

2019 Physician Work RVUs

2019 Total RVUs

93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement

$620 10.24 17.20

93653 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary) and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry (Do not report 93653 in conjunction with 93600-3, 93610, 93612, 93618-20, 93642, 93654, 93656)

$878 14.75 24.36

93654 …with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed (Do not report 93654 in conjunction with 93279-84, 93286-9, 93600-3, 93609-10, 93612-3, 93618-20, 93622, 93642, 93653, 93656)

$1,175 19.75 32.60

93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation (Do not report 93656 in conjunction with 93279-84, 93286-9, 93462, 93600, 93602-3, 93610, 93612, 93618-21, 93653-4)

$1,178 19.77 32.70

The ablation procedure codes 93650, 93653, 93654, and 93656 are distinct primary procedure codes and may not be reported together.

4 of 8 April 2019

CPT3 Code CPT3 Code Description

2019 Medicare National Physician Rate4

2019 Physician Work RVUs

2019 Total RVUs

+93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (Use 93655 in conjunction with 93653-4, 93656)

$447 7.50 12.40

+93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (Use 93657 in conjunction with 93656)

$446 7.50 12.38

+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (Use 93462 in conjunction with 33477, 93452-3, 93458-93461, 93582, 93653-4) (Do not report 93462 in conjunction with 93656) (Do not report 93462 in conjunction with 0345T unless transapical puncture is performed)

$220 3.73 6.11

Add-on codes +93655 and +93657 may be applicable when intracardiac catheter ablation of a discrete arrhythmia is performed after the treatment of the primary ablated mechanism.

When reporting ablation therapy codes (93653–93657), comprehensive EPS may not be separately reported.

Diagnostic Electrophysiologic Study (EPS)Coding information to be used when a physician performs a diagnostic electrophysiologic study (EPS) prior to a catheter ablation on a different date of service (DOS).

Note: The payment rates and RVUs in the table below are for the professional component for all codes, with the exception of 93613. For each of those codes, these are the payments for the professional component as billed with modifier 26.

CPT3 Code CPT3 Code Description

2019 Medicare National Physician Rate4

2019 Physician Work RVUs

2019 Total RVUs

93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia (Do not report 93619 in conjunction with 93600, 93602-3, 93610, 93612, 93618, 93620-2, 93653-7)

$410 (26) 7.06 11.37

93620 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording (Do not report 93620 in conjunction with 93600, 93602-3, 93610, 93612, 93618-9, 93653-7)

$659 (26) 11.32 18.28

+93621 with left atrial pacing and recording from coronary sinus or left atrium (Use 93621 in conjunction with 93620, 93653-4) (Do not report 93621 in conjunction with 93656)

$122 (26) 2.10 3.39

+93622 with left ventricular pacing and recording (Use 93622 in conjunction with 93620, 93653, 93656) (Do not report 93622 in conjunction with 93654)

$181 (26) 3.10 5.02

+93623 Programmed stimulation and pacing after intravenous drug infusion (Use 93623 in conjunction with 93610, 93612, 93619-20, 93653-4, 93656)

$166 (26) 2.85 4.61

+93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (Use 93662 in conjunction with 92987, 93453, 93460-2, 93532, 93580-1, 93620-2, 93653-4, 93656 as appropriate) (Do not report 92961 in addition to 93662)

Carrier-priced 2.80 4.07

93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia

$254 (26) 4.55 7.04

Mapping is considered a distinct procedure performed in addition to a diagnostic EPS or ablation procedure and may be separately reported.

+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (Use 93609 in conjunction with 93620, 93653, 93656) (Do not report 93609 in conjunction with 93613, 93654)

$292 (26) 4.99 8.10

+93613 Intracardiac electrophysiologic 3-dimensional mapping (Use 93613 in conjunction with 93620, 93653, 93656) (Do not report 93613 in conjunction with 93609, 93654)

$311 5.23 8.63

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INPATIENT HOSPITAL CODINGICD-10-PCS5 Procedure Codes for Percutaneous Ablation ProceduresThe following ICD-10 procedure codes describe commonly performed percutaneous ablation procedures. This is not an all-inclusive list. These codes are only used by hospitals for reporting inpatient services.

ICD-10-PCS5 Procedure Code ICD-10-PCS5 Procedure Code Description4A023FZ Measurement of cardiac rhythm, percutaneous approach

02K83ZZ Map conduction mechanism, percutaneous approach

02583ZZ Destruction of conduction mechanism, percutaneous approach

Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) Medicare reimbursement for inpatient hospital services is based on a classification system known as Medicare Severity Diagnosis Related Groups (MS-DRGs). MS-DRG assignment is determined by patient diagnoses and procedures. Only one MS-DRG is assigned per hospital admission, and one payment is made for all procedures and supplies related to that inpatient stay. MS-DRG assignment may be affected when one or more secondary diagnoses that are included in the major complication or comorbidity (MCC), or complication or comorbidity (CC) lists are present. MCC and CC lists are updated annually and maintained by CMS.

MS-DRG Brief MS-DRG Description

2019 Medicare National Inpatient Rate6

273 Percutaneous intracardiac procedures w/MCC $22,300

274 Percutaneous intracardiac procedures w/o MCC $18,184

April 2019

CPT3 Code CPT3 Code Description

2019 Medicare National Physician Rate4

2019 Physician Work RVUs

2019 Total RVUs

99151 Mod sed same phys/qhp < 5 yrs $26 0.50 0.72

99152 Mod sed same phys/qhp ≥ 5 yrs $13 0.25 0.35

+99153 Mod sed same phys/qhp ea N/A 0.00 N/A

99155 Mod sed oth phys/qhp < 5 yrs $92 1.90 2.54

99156 Mod sed oth phys/qhp ≥ 5 yrs $81 1.65 2.24

+99157 Mod sed other phys/qhp ea $66 1.25 1.82

Moderate Sedation

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Medicare Hospital Outpatient Catheter Ablation C-Code ListingC1730 — Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (19 or Fewer Electrodes)

Device Model NumberTorqr™ CS Diagnostic Catheter 041565CS, 041590CS, 041865CS

Torqr™, Soloist™ Diagnostic Catheter 041002JM, 041002UM, 041005DM, 041005JM, 041005UM, 04130DS, 04122JM, 04122UM, 04125JM, 04125UM, 441016JF, 441016U, 44216J, 44216JF, 44216U, 44516J, 44516JF, 44516U

Marinr™ CS 043302M, 043325M, 043328M

Marinr™ 072302, 072322M, 072402

Achieve™ Mapping Catheter 990063-015, 990063-020

Achieve Advance™ Mapping Catheter 2ACH15, 2ACH20, 2ACH25

C1731 — Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (20 or More Electrodes)

Device Model NumberStableMapr™ 04401SM, 04402SM

April 2019

OUTPATIENT HOSPITAL CODINGComprehensive Ambulatory Payment Classifications (C-APCs)Hospital outpatient reimbursement is subject to various packaging rules, including comprehensive APCs (C-APCs). Under C-APCs, only one payment is made for all procedures and supplies provided during the outpatient episode of care.

CPT3 Code Brief Description

2019 Medicare National Hospital Outpatient Rate7 C-APC C-APC Description

93619 Electrophysiology eval w/o arrhythmia

$5,097 5212 Level 2 Electrophysiologic Procedures93620 Electrophysiology eval w/arrhythmia

93624 EP follow-up study

93650 AV node ablation

93653 SVT ablation and EP eval

$19,124 5213 Level 3 Electrophysiologic Procedures93654 VT ablation and EP eval

93656 Ablation of AF by PVI with transseptal and EP evaluation

The following add-on codes are not assigned to an APC as they are ancillary to the primary procedures. Medicare classifies the following codes with an “N” status indicator and does not separately reimburse hospitals for these procedures.

+93462 Transseptal puncture (Use 93462 in conjunction with 33477, 93452-3, 93458-61, 93461, 93582-4) (Do not report 93642 in conjunction with 93656) (Do not report 93462 in conjunction with 0345T unless transapical puncture is performed)

+93609 Intraventricular and/or intra-atrial mapping (Use 93609 in conjunction with 93620, 93653, 93656) (Do not report 93609 in conjunction with 93613, 93654)

+93613 Intracardiac 3-dimensional mapping (Use 93613 in conjunction with 93620, 93653, 93656) (Do not report 93613 in conjunction with 93609, 93654)

+93621 Comprehensive EP evaluation; with left atrial pacing and recording from coronary sinus or left atrium (Use 93621 in conjunction with 93620, 93653-4) (Do not report 93621 in conjunction with 93656)

+93622 Comprehensive EP evaluation; with left ventricular pacing and recording (Use 93622 in conjunction with 93620, 93653, 93656) (Do not report 93622 in conjunction with 93654)

+93623 Programmed stimulation and pacing after intravenous drug infusion (Use 93623 in conjunction with 93610, 93612, 93619-20, 93653-4, 93656)

+93655 Additional ablation of discrete arrhythmia, SVT or VT (Use 93655 in conjunction with 93653-4, 93656)

+93657 Additional linear focal lesion for AF (Use 93657 in conjunction with 93656)

+93662 Intracardiac echocardiography (Use 93662 in conjunction with 92987, 93453, 93460-2, 93532, 93580-1, 93620-2, 93653-4, 93656 as appropriate) (Do not report 92961 in addition to 93662)

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FREQUENTLY ASKED REIMBURSEMENT QUESTIONS1 . Can I bill for pacemaker programming on the same day as an AF ablation?

No. There are CCI edits that prohibit these from being billed together.

2 . If a VT and SVT ablation are both performed on a patient on the same DOS/same encounter, which procedure should I code as primary? The primary procedure depends on the documentation provided by the physician.

3 . How do I code AV node ablation with mapping? Use 93650 and 93613.

References1 International Classification of Diseases, Tenth Revision, Clinical Modification. Available at: https://www.cdc.gov/nchs/icd/icd10cm.htm#FY%202019%20

release%20of%20ICD-10-CM. Accessed December 17, 2018.2 Social Security Act Section 1862 42 U.S.C. 1395y(a)(1)(A). Available at: http://www.ssa.gov/OP_Home/ssact/title18/1862.htm. Accessed January

14, 2019.3 Current Procedural Terminology (CPT) is ©2018 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative causes, or

related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.

4 CMS-1693-F Medicare Physician Fee Schedule Final Rule for 2019, Addendum B. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending. Accessed January 14, 2019. Physician Fee Schedule rates listed are the facility rates — the payment a physician receives when performing the service in a facility place of service.

5 2019 ICD-10-PCS International Classification of Diseases, Tenth Revision, Procedure Coding System. Available at: https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html. Accessed December 17, 2018.

6 Hospital Inpatient Medicare regulation and data files. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page.html Accessed January 14, 2019.

7 CMS-1695-FC Hospital Outpatient Prospective Payment Final Rule for CY 2019, Addendum B. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1695-FC.html. Accessed January 14, 2019.

C1733 — Catheter, Electrophysiology, Diagnostic/Ablation, Other than 3D or Vector Mapping, Other than Cool Tip

Device Model NumberRF Enhancr™ II 31744523, 31745523, 31745533, 39745533, 39746534

RF Contactr™ 70256034, 70257533

RF Conductr™ MC 0786022, 0786042, 0787533, 0787544, 07857544, 07856042, 07856044, 0786044

RF Marinr™ MC 075302, 075312, 075402, 075405

5F RF Marinr™ 076514, 076515, 076583, 076584, 076585, 076586

Freezor™ Cardiac CryoAblation Catheter

307F1, 307F3, 307F5

Freezor™ MAX Cardiac CryoAblation Catheter

239F3, 239F5

Freezor™ Xtra Cardiac CryoAblation Catheter

227F1, 227F3, 227F5

Arctic Front Advance™ Cardiac CryoAblation Catheter

2AF234, 2AF284

Arctic Front Advance Pro™ Cryoballoon Catheter

AFAPRO23, AFAPRO28

C1766 — Introducer/Sheath, Guiding, Intracardiac Electrophysiological, Steerable, Other than Peel-away

Device Model NumberFlexCath Advance™ Steerable Sheath 4FC12

For other questions, please contact our Reimbursement Services team by phone at 866-877-4102 or by email at: rs.healthcareeconomics@medtronic.com.