CMS will pay for certain angioplasty and stenting procedures in ASCs beginning Jan. 1, under its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule.
Five things to know:
1. ASCs will be eligible to receive payment for CPT codes "covering percutaneous transluminal coronary angioplasty with or without placement of stents in a single major coronary artery or branch, as well as in each additional branch of a major coronary artery," TCMD reported.
2. Here are the CPT codes for three coronary intervention procedures and three associated add-on procedures that CMS added to the ASC Covered Procedure List for 2020:
- 92920: Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
- 92921: Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
- 92928: Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
- 92929: Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
- C9600: Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
- C9601: Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
3. The additions to the ASC Covered Procedures List come despite the fact that these procedures may involve major blood vessels, which has been a sticking point for CMS in the past.
4. The agency noted that "a majority of Medicare beneficiaries may not be suitable candidates to receive these procedures in an ASC setting due to factors such as age and comorbidities" and encouraged careful patient selection.
5. CMS predicts that Medicare payments will drop by $20 million and beneficiary copayments will decline by $5 million in 2020 if 5 percent of coronary intervention procedures migrate from the hospital outpatient setting to ASCs as a result of the change.