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«This document provides a complete list of the device category HCPCS codes used presently or previously for pass-through payment, along with their ...»

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List of Device Category Codes for Present or Previous Pass-Through Payment and Related

Definitions

Effective: January 1, 2016

This document provides a complete list of the device category HCPCS codes used presently or

previously for pass-through payment, along with their expiration dates, and definitions we

published for certain device category C-codes. Please note that this list does not include all

device codes reportable under the OPPS; there are additional HCPCS codes for devices that were not eligible for pass-through payment. See section 61, Chapter 4 of the IOM, pub. 100-4, currently available at https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads/clm104c04.pdf, for detailed information on requirements for reporting device codes and satisfying device edits in the OPPS.

Section 402(a) of the Benefits Improvement and Protection Act of 2000 (BIPA), which was enacted on December 21, 2000, required the creation of categories for pass-through devices under the hospital OPPS. As a result of BIPA, new category codes were created for pass-through devices that became effective April 1, 2001.

As indicated in section 1833(t)(6) of the Social Security Act, payments for pass-through devices are limited to at least two years but no more than three years. Note that payment for passthrough devices is based on the charge on the individual bill, converted to cost by application of a hospital-specific cost-to-charge ratio, and subject (in some instances) to a reduction that offsets the cost of similar devices already included in the APC payment rate for the associated procedure.

When the category codes became effective April 1, 2001, many of the item-specific C-codes that were cross-walked in Transmittal A-01-41 and Transmittal A-01-97 to the new category codes were approved for pass-through status before April 1, 2001. In determining the expiration dates for those initial pass-through device category codes listed below, we determined when specific devices that are described by the categories were paid as pass-through devices through their item-specific C-codes prior to the creation of the categories, pursuant to the statute, section 1833(t)(6)(iii)(I). These dates are listed in the column below entitled "Date First Populated."

Thus, many of the category codes that were made effective April 1, 2001 expired on December 31, 2002. Despite the expiration of pass-through payment status for device category codes, hospitals are still required to report the device category C-codes on claims when such devices are used in conjunction with procedures billed and paid under the OPPS.

In the CY 2015 final rule, we finalized a policy and implemented claims processing edits that require any of the device codes used in the previous device-to-procedure edits to be present on the claim whenever a procedure code assigned to any of the APCs listed in Table H1 (the formerly device dependent APCs) is reportedon the claim (79 FR 66795).

List of Device Category HCPCS Codes and Definitions Used for Present and Previous PassThrough Payment ***

–  –  –

# The brachytherapy descriptors were changed to the ones shown above, effective 7/1/07. These 6 brachytherapy source codes were paid as pass-through devices from 2000 through 2002, as noted.

Beginning in 2004, all brachytherapy sources have been paid separately as non-pass-through items from the procedure with which they are billed, and additional brachytherapy source HCPCS codes have been added for payment. To see the most current comprehensive list of brachytherapy source codes, see the latest OPPS/ASC final rule.

Explanations of Terms/Definitions Related to Pass-Through Device Category Codes 3D mapping catheter (C1732) - Refers to a catheter used for mapping the electrophysiologic properties of the heart. Signals are identified by a specialized catheter and changed into a 3-dimensional map of a specific region of the heart.

Adaptor for a pacing lead (C1883) - Interposed between an existing pacemaker lead and a new generator. The end of the adaptor lead has the appropriate connector pin that will enable utilization of the existing pacemaker lead with a new generator that has a different receptacle. These are required when a generator is replaced or when two leads are connected to the same port in the connector block.

Adhesion barrier (C1765) - A bioresorbable substance placed on and around the neural structures, which inhibits cell migration (fibroblasts) and minimizes scar tissue formation. It is principally used in spine surgeries, such as laminectomies and diskectomies.

Anchor for opposing bone-to-bone or soft tissue-to-bone (C1713) - Implantable pins and/or screws that are used to oppose soft tissue-to-bone, tendon-to-bone, or bone-to-bone. Screws oppose tissues via drilling as follows: soft tissue-to-bone, tendon-to-bone, or bone-to-bone fixation. Pins are inserted or drilled into bone, principally with the intent to facilitate stabilization or oppose bone-to-bone. This may include orthopedic plates with accompanying washers and nuts.

This category also applies to synthetic bone substitutes that may be used to fill bony void or gaps (i.e., bone substitute implanted into a bony defect created from trauma or surgery).

Balloon dilatation catheter, non-vascular (C1726) - Catheter used to dilate strictures or stenoses through the insertion of an uninflated balloon affixed to the end of a flexible catheter, followed by the inflation of the balloon at the specified site (e.g., common bile duct, ureter, small or large intestine). [For the reporting of vascular balloon dilatation catheters, see category "Transluminal angioplasty catheter" (C1725 and C1885).] Balloon tissue dissector catheter (C1727) - Balloon tipped catheter used to separate tissue planes, used in procedures such as hernia repairs.





Catheter, ablation, non-cardiac, endovascular (implantable) (C1888) – A radiofrequency or laser catheter designed to occlude or obliterate blood vessels (e.g., veins).

Cardioverter-defibrillator, other than single or dual chamber (C1882) - Includes cardiac resynchronization devices.

Coated stent (C1874, C1875) - Refers to a stent bonded with drugs (e.g., heparin), layered with biocompatible substances (e.g., phosphorylcholine), or with silicone or a silicone derivative (e.g., PTFE, polyurethane).

Connective tissue, human (C1762) - These tissues include a natural, cellular collagen or extracellular matrix obtained from autologous rectus fascia, decellularized cadaveric fascia lata, or decellularized dermal tissue. They are intended to repair or support damaged or inadequate soft tissue. They are used to treat urinary incontinence resulting from hypermobility or Intrinsic Sphincter Deficiency (ISD), pelvic floor repair, or for implantation to reinforce soft tissues where weakness exists in the urological anatomy. Note this excludes those items that are used to replace skin. For reporting mesh when used to treat urinary incontinence, see the category “Mesh.” For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category “Urinary incontinence repair device.” Connective tissue, non-human (includes synthetic) (C1763) - These tissues include a natural, acellular collagen matrix typically obtained from porcine or bovine small intestinal submucosa, or pericardium. This bio-material is intended to repair or support damaged or inadequate soft tissue.

They are used to treat urinary incontinence resulting from hypermobility or Intrinsic Sphincter Deficiency (ISD), pelvic floor repair, or for implantation to reinforce soft tissues where weakness exists in the urological or musculoskeletal anatomy. [This excludes those items that are used to replace skin.] [For reporting mesh when used to treat urinary incontinence, see the category “Mesh.”] [For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category “Urinary incontinence repair device.”] Cool-tip electrophysiology catheter (C2630) - Ablation catheter that contains a cooling mechanism and has temperature sensing capability.

Covered stent (C1874, C1875) - Refers to a stent layered with silicone or a silicone derivative (e.g., PTFE, polyurethane).

Drainage catheter (C1729) - Intended to be used for percutaneous drainage of fluids. (NOTE:

This category does NOT include Foley catheters or suprapubic catheters. Refer to category C2627 to report suprapubic catheters.) Electrophysiology catheter (C1730, C1731, C1732, C1733, C2630) - Assists in providing anatomic and physiologic information about the cardiac electrical conduction system.

Electrophysiology catheters are categorized into two main groups: (1) diagnostic catheters that are used for mapping, pacing, and/or recording only, and (2) ablation (therapeutic) catheters that also have diagnostic capability. The electrophysiology ablation catheters are distinct from non-cardiac ablation catheters.

Electrophysiology catheters designated as "cool-tip" refer to catheters with tips cooled by infused and/or circulating saline. Catheters designated as "other than cool-tip" refer to the termister tip catheter with temperature probe that measures temperature at the tissue catheter interface.

Embolization protective system (C1884) – A system designed and marketed for use to trap, pulverize, and remove atheromatous or thrombotic debirs from the vascular system during an angioplasty, atherectomy, or stenting procedure.

Extension for a pacing lead (C1883) - Provides additional length to an existing pacing lead but does not have the capability of an adaptor.

Extension for a neurostimulator lead (C1883) - Conducts electrical pulses from the power source (generator or neurostimulator) to the lead. The terms neurostimulator and generator are used interchangeably.

Guiding catheter (C1887) - Intended for the introduction of interventional/diagnostic devices into the coronary or peripheral vascular systems. It can be used to inject contrast material, function as a conduit through which other devices pass, and/or provide a mechanism for measuring arterial pressure, and maintain a pathway created by the guide wire during the performance of a procedure.

Infusion pump, non-programmable, temporary (implantable) (C2626) - Short-term pain management system that is a component of a permanent implantable system used for chronic pain management.

Integrated keratoprosthesis (C1818) – The device is composed of a flexible, one-piece biocompatible polymer. It is used to replace diseased corneas in conditions and patient states where traditional corneal transplantation is not indicated or possible. Implantation of the procedure is done in a two-stage surgical approach.

Intraocular lens (new technology) (C1780) - Refers to the intraocular lenses approved by CMS as "new technology IOL." A list of these lenses is published periodically in the Federal Register.

The latest publication can be found on page 25740 of the Federal Register notice dated May 3, 2000.

Intraoperative ocular device for detached retina (C1784) - A perfluorocarbon substance instilled during a vitreoretinal procedure to treat detached retina.

Joint device (C1776) - An artificial joint that is implanted in a patient. Typically, a joint device functions as a substitute to its natural counterpart and is not used (as are anchors) to oppose soft tissue-to-bone, tendon-to-bone, or bone-to-bone.

Left ventricular coronary venous system lead (C1900) - Designed for left heart placement in a cardiac vein via the coronary sinus and is intended to treat the symptoms associated with heart failure. This code should be reported with CPT codes 33224 or 33225.

Liquid pulmonary sealant (C2615) - An absorbable, synthetic solution that forms a seal utilizing a photochemical polymerization process. It is used to seal visceral pleural air leaks incurred during pulmonary resection.

Material for vocal cord medialization, synthetic (C1878) - Synthetic material that is composed of a non-absorbable substance such as silicone and can be injected or implanted to result in vocal cord medialization.

Mesh (C1781) - A mesh implant or synthetic patch composed of absorbable or non-absorbable material that is used to repair hernias, support weakened or attenuated tissue, cover tissue defects, etc. [For reporting connective tissue (human or non-human) when used to treat urinary incontinence, see the category “Connective tissue, human” or “Connective tissue, non-human.”] [For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category “Urinary incontinence repair device.”] Morcellator (C1782) - Used for cutting, coring, and extracting tissue in laparoscopic procedures.

These are distinct from biopsy devices because morcellators are used for the laparoscopic removal of tissue.

Pacemaker, other than single or dual chamber (C2621) - Includes cardiac resynchronization devices as well as other pacemakers that are neither single or dual chamber.

Patient programmer (C1787) - Programmer that allows the patient to operate their neurostimulator, for example, programming the amplitude and rate of stimulation of a neurostimulator system. Only a non-console patient programmer is eligible for transitional passthrough payments.

Peel-away introducer/sheath (C1892) - A non-absorbable sheath or introducer that separates into two pieces. This device is used primarily when removal of the sheath is required after a catheter or lead is in the desired position.

Retinal tamponade device, silicone oil (C1814) – A device used as a permanent/prolonged retinal tamponade in the treatment of complex retinal detachments. This is used as a post-operative retinal tamponade following vitreoretinal surgery.

Retrieval device, insertable (C1773) - A device designed to retrieve other devices or portions thereof (e.g., fractured catheters, leads) lodged within the vascular system. This can also be used to retrieve fractured medical devices or to exchange introducers/sheaths.

Septal defect implant system (C1817) - An intracardiac metallic implant used for closure of various septal defects within the heart. The septal defect implant system includes a delivery catheter. The category code for the septal defect implant system (C1817) includes the delivery catheter; therefore, the delivery catheter should not be reported separately.



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