DCB Reimbursement

Help inform Medicare CY2019 payment rates by capturing utilization of DCBs

  • 2018 DCB reimbursement will be bundled into the procedure payment for outpatient cases
  • Physicians should continue to document how many DCBs they utilize
  • Coding staff should continue to use HCPCS code C2623 and document the number of DCBs used, as well as related hospital costs
  • Hospitals update chargemaster to include HCPCS code C2623 for all drug-coated balloons utilized in endovascular procedures (CPT codes 37224, 37225, 37226, 37227)

OUTPATIENT

ProcedureMedicare Hospital Outpatient19,20
CPT Codes / APC201820
Angioplasty w/ or w/o DCB37224
APC 5192
$5,085
Angioplasty w/ or w/o DCB + Atherectomy37225
APC 5193
$10,510
Angioplasty w/ or w/o DCB + Stent37226
APC 5193
$10,510
Angioplasty w/ or w/o DCB + Atherectomy + Stent37227
APC 5194
$16,019
  • DCBs are paid in the angioplasty modalities
  • Payment levels for endovascular procedures increased up to 8% over 2017
  • Report DCB procedures using HCPCs C2623
  • Reporting DCB costs may assist 2019 reimbursement level

INPATIENT

MS-DRGDescription2018 Medicare Natl
Average Payment21
252Other vascular procedures w/ MCC$19,486
253Other vascular procedures w/ CC$15,277
254Other vascular procedures w/o CC/MCC$10,924
  • Paid under Medicare Severity Diagnostic Related Group
  • Payment based on severity level
  • Major complications and comorbidities (MCC) or (CC)

PHYSICIAN/OBL

Procedure2018 Medicare Physician Payment22
 CPT CodesHospitalOBL
Angioplasty w/ or w/o DCB37224$467$3,777
Angioplasty w/ or w/o DCB + Atherectomy37225$638$11,063
Angioplasty w/ or w/o DCB + Stent37226$551$9,065
Angioplasty w/ or w/o DCB + Atherectomy + Stent37227$769$14,987
  • Physicians receive separate payment for inpatient or outpatient services
  • OBL payments include facility, physician and device costs
  • Physicians should say “DCB” during dictation and note how many are used
Stellarex DCB Ballon

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