Intravascular lithotripsy (IVL) is a groundbreaking treatment for calcified plaque in the coronary and peripheral arteries. Understanding the insurance reimbursement landscape for IVL procedures is critical for healthcare professionals and hospital administrators. In this article, we’ll explain the IVL reimbursement picture and list relevant reimbursement codes and payments for current IVL procedures.

IVL Reimbursement Depends on the Procedure’s Location and Application

Reimbursement for intravascular lithotripsy differs depending on the procedure’s application, either peripheral or coronary. Several factors influence these rates, including the procedure's nature, case complexity, and specific payer policies. This article gives a good overview of what happens during an IVL procedure. Below, we cover the reimbursement payments available for coronary and peripheral IVL procedures. 

Understanding the Reimbursement Landscape for Coronary IVL Procedures

Coronary IVL reimbursement was initiated in 2021 and has seen major developments in the years since. The Centers for Medicare & Medicaid Services (CMS) have instituted new Medicare Severity Diagnosis Related Group (MS-DRG) codes and payments for coronary IVL procedures conducted in the hospital inpatient environment. 

These codes are an important element of the FY2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule, set to be effective from October 1, 2023. This introduction involves three novel codes delineating percutaneous coronary interventions (PCI) that incorporate coronary IVL. These include hospital inpatient options with and without an intraluminal device (stent implant). 

In August 2023, Shockwave Medical, developers of intravascular lithotripsy (IVL) technology, announced a pivotal update featuring new CMS codes for coronary IVL procedures and increased payments.(1) You can learn more about the leading IVL companies and products in this article.

New Coronary IVL-Specific Reimbursement Codes Offer Higher Payments

Newer coronary IVL-specific MS-DRGs offer higher payments compared to other PCI procedural reimbursements. The corresponding codes and estimated payments include: 

• MS-DRG 323: Coronary IVL with an intraluminal device, with major complications and comorbidities (MCC); projected payment: $28,987

• MS-DRG 324: Coronary IVL with an intraluminal device, without MCC; projected payment: $20,785

• MS-DRG 325: Coronary IVL without an intraluminal device, without CC/MCC; projected payment: $18,514 

New Technology Add-on Payment (NTAP) for Coronary IVL Reimbursements Has Ended

Until recently, hospitals in the US leveraged the New Technology Add-On Payment (NTAP) for coronary IVL reimbursements, providing an additional payment of up to $3,666 in conjunction with the prevailing MS-DRG payment for PCI procedures within hospital inpatient settings. However, this NTAP arrangement concluded on September 30, 2023. 

In order to streamline the transition, CMS analyzed data from the NTAP program to refine the coding and payment systems for future coronary IVL procedures. Following an initial proposal in April and a 60-day public consultation period, the changes have been incorporated into the finalized reimbursement.

Understanding the Reimbursement Landscape for Peripheral IVL Procedures

CMS began providing reimbursement for IVL procedures in peripheral arteries starting at the beginning of 2020. Peripheral IVL reimbursement has evolved considerably in recent years, with coverage in outpatient settings, inpatient environments, and Ambulatory Surgical Centers (ASC). As of 2023, Medicare has introduced payment enhancements for IVL treatments targeting iliac, femoral, popliteal, and below-the-knee arteries in the ASC context.

The peripheral IVL reimbursement rates and specifics can be influenced by various factors, including the nature of the procedure and the setting in which it's conducted. For a comprehensive understanding, consult with reimbursement specialists who can provide real-time answers and guidance regarding billing and coding.

The Future of IVL Procedures, Reimbursements, and Payments

IVL has become an essential tool in the treatment of calcification in peripheral and coronary arteries. As IVL technologies and devices continue to improve and new technologies become available, we can expect to see new CMS codes and payments. This article gives a look at the exciting advances in IVL that are currently underway. To learn more about IVL in general, this article gives an overview of the science and technology behind these innovative vascular procedures.