Reimbursement for a product or procedure may vary depending upon the setting in which the product is used. The reimbursements listed in this guide are based on Medicare National Average Payment or Rates therefore actual reimbursement rates will vary for each provider or institution.
Healthcare Coding Systems
CPT® |
Current Procedural Terminology used by healthcare providers, payers and facilities to code procedures and services in all settings of care and reimbursement that a practitioner will receive for services provided |
HCPCS |
Healthcare Common Procedure Coding System that is broken into Level I and II. Level I utilizes CPT coding and Level II identifies products, supplies, and services not included in CPT |
APC |
Ambulatory Payment Classification that is the unit of payment in most cases under the Hospital Outpatient Prospective Payment System (OPPS) which the Centers for Medicare & Medicaid Services (CMS) assigns HCPCS codes to APCs based on similar clinical characteristics and similar costs |
ASC |
Ambulatory Surgery Centers payment group utilizes HCPCS codes assigned to each of the procedure codes and determines the amount that Medicare pays for facility services furnished in connection with a covered procedure |
ICD-10-PCS |
Procedural codes (PCS) from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) used on hospitalized inpatients. ICD-10-CM comes from the same revision but is specific to clinical modifiers for diagnosing (CM) |
MS-DRG |
The Medicare Severity Diagnosis Related Groups is a classification system for an inpatient stay based on principal diagnosis, additional diagnoses, and procedures |
C-Code |
Unique temporary pricing codes established by the Centers for Medicare and Medicaid Services (CMS) and only valid for Medicare on claims for hospital outpatient department services and procedures |
Select a category to view coding & reimbursement information.
IVC Filters Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
37191 |
Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed |
$2,455.90 |
$233.86 |
5184 |
$4,596.19 |
N/A |
37192 |
Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed |
$1,381.87 |
$361.87 |
5183 |
$2,771.28 |
N/A |
37193 |
Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed |
$1,627.28 |
$365.59 |
5183 |
$2,771.28 |
N/A |
ICD-10-PCS4 |
Description |
06H03DZ |
Insertion of Intraluminal Device in Inferior Vena Cava, Percutaneous Approach |
06WY3DZ |
Revision of Intraluminal Device in Lower Vein, Percutaneous Approach |
06PY3DZ |
Removal of Intraluminal Device from Lower Vein, Percutaneous Approach |
MS-DRG5 |
Description |
252 |
Other Vascular Procedures with MCC |
253 |
Other Vascular Procedures with CC |
254 |
Other Vascular Procedures without CC/MCC |
C-Code6 |
Description |
C1773 |
Retrievable device, insertable |
C1880 |
Vena cava filter |
C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
Retrievals Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
37193 |
Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed |
$1627.28 |
$365.59 |
5183 |
$2,771.28 |
N/A |
37197 |
Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed |
$1647.85 |
$315.42 |
5183 |
$2,771.28 |
$1,341 |
ICD-10-PCS4 |
Description |
05PY3DZ |
Removal of Intraluminal Device from Upper Vein, Percutaneous Approach |
06PY3DZ |
Removal of Intraluminal Device from Lower Vein, Percutaneous Approach |
05WY3DZ |
Revision of Intraluminal Device from Upper Vein, Percutaneous Approach |
06WY3DZ |
Revision of Intraluminal Device from Lower Vein, Percutaneous Approach |
MS-DRG5 |
Description |
252 |
Other vascular procedures with MCC |
253 |
Other vascular procedures with CC |
254 |
Other vascular procedures without CC/MCC |
C-Code6 |
Description |
C1773 |
Retrieval device, insertable (used to retrieve fractured medical devices) |
Mechanical Thrombectomy Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
Dialysis Circuit Imaging and Intervention |
||||||
36904 |
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s); |
$1,975.91 |
$387.60 |
5192 |
$4,953.91 |
$2,875.24 |
36905 |
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty |
$2,481.16 |
$464.83 |
5193 |
$9,908.48 |
$4,182.94 |
36906 |
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s);with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit |
$6,556.04 |
$536.65 |
5194 |
$15,939.97 |
$10,182.24 |
Venous Mechanical Thrombectomy |
||||||
37187 |
Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance |
$1,986.73 |
$411.78 |
5192 |
$4,953.91 |
$3,102.97 |
37188 |
Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy |
$1,671.76 |
$292.33 |
5183 |
$2,771.28 |
$1,341.23 |
ICD-10-PCS4 |
Description |
05C_3ZZ |
Extirpation of Matter from Upper Veins, Percutaneous Approach |
06C_3ZZ |
Extirpation of Matter from Lower Veins, Percutaneous Approach |
MS-DRG5 |
Description |
252 |
Other Vascular Procedures with MCC |
253 |
Other Vascular Procedures with CC |
254 |
Other Vascular Procedures without CC/MCC |
270 |
Other Major Cardiovascular Procedures with MCC |
271 |
Other Major Cardiovascular Procedures with CC |
272 |
Other Major Cardiovascular Procedures without MCC/CC |
C-Code6 |
Description |
C1757 |
Catheter, thrombectomy/embolectomy |
Soft Tissue Biopsy Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
Thyroid Biopsy |
||||||
60100 |
Biopsy thyroid, percutaneous core needle |
$114.76 |
$81.20 |
5071 |
$610.01 |
$53.77 |
Pleura Biopsy |
||||||
32400 |
Biopsy, pleura; percutaneous needle |
$164.57 |
$89.50 |
5072 |
$1,372.60 |
$576.39 |
Lung Biopsy |
||||||
32405 |
Biopsy, lung or mediastinum, percutaneous needle |
$408.53 |
$93.47 |
5072 |
$1,372.60 |
$576.39 |
Lymph Node Biopsy |
||||||
38505 |
Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) |
$128.12 |
$72.90 |
5072 |
$1,372.60 |
$576.39 |
Liver Biopsy |
||||||
47000 |
Biopsy of liver, needle; percutaneous |
$319.39 |
$92.39 |
5072 |
$1,372.60 |
$576.39 |
47001 |
Biopsy of liver, needle; when done for indicated purpose at time of other major procedure |
$109.71 |
$109.71 |
N/A |
N/A |
Packaged |
Retroperitoneum or Abdomen Biopsy |
||||||
49180 |
Biopsy, abdominal or retroperitoneal mass, percutaneous needle |
$175.40 |
$87.70 |
5072 |
$1,372.60 |
$576.39 |
Pancreas Biopsy |
||||||
48102 |
Biopsy of pancreas, percutaneous needle |
$555.78 |
$249.74 |
5072 |
$1,372.60 |
$576.39 |
Kidney Biopsy |
||||||
50200 |
Renal biopsy; percutaneous by trocar or needle |
$558.31 |
$133.53 |
5072 |
$1,372.60 |
$576.39 |
Prostate Biopsy |
||||||
55700 |
Biopsy, prostate; needle or punch, single or multiple, any approach |
$255.88 |
$136.06 |
5373 |
$1,771.55 |
$789.71 |
55706 |
Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance |
$387.96 |
$387.96 |
5373 |
$1,771.55 |
$789.71 |
Muscle Biopsy |
||||||
20206 |
Biopsy, muscle, percutaneous needle |
$243.97 |
$61.27 |
5072 |
$1,372.60 |
$576.39 |
Fine Needle Aspiration |
||||||
10021 |
Fine needle aspiration, without imaging guidance; first lesion |
$101.05 |
$57.74 |
5052 |
$319.51 |
$59.19 |
10004 |
Fine needle aspiration, without imaging guidance; each additional lesion |
$53.41 |
$45.11 |
N/A |
N/A |
N/A |
10005 |
Fine needle aspiration, including ultrasound guidance; first lesion |
$132.45 |
$74.71 |
N/A |
N/A |
$75.07 |
10006 |
Fine needle aspiration, including ultrasound guidance; each additional lesion |
$61.35 |
$51.25 |
N/A |
N/A |
N/A |
10007 |
Fine needle aspiration, including fluoroscopic guidance; first lesion |
$304.24 |
$97.08 |
N/A |
N/A |
$232.42 |
10008 |
Fine needle aspiration, including fluoroscopic guidance; each additional lesion |
$172.87 |
$63.52 |
N/A |
N/A |
N/A |
10009 |
Fine needle aspiration, including Computed Tomography guidance; first lesion |
$480.71 |
$118.37 |
N/A |
N/A |
$308.23 |
10010 |
Fine needle aspiration, including Computed Tomography guidance; each additional lesion |
$289.44 |
$85.89 |
N/A |
N/A |
N/A |
10011 |
Fine needle aspiration, including Magnetic Resonance guidance; first lesion |
N/A |
N/A |
N/A |
N/A |
N/A |
10012 |
Fine needle aspiration, including Magnetic Resonance guidance; each additional lesion |
N/A |
N/A |
N/A |
N/A |
N/A |
ICD-10-PCS4 |
Description |
0G9G3ZX |
Drainage of Fluids and/or Gases from Thyroid Gland Lobe, Left, Percutaneous Approach, Diagnostic |
0G9H3ZX |
Drainage of Fluids and/or Gases from Thyroid Gland Lobe, Right, Percutaneous Approach, Diagnostic |
0G9K3ZX |
Drainage of Fluids and/or Gases from Thyroid Gland, Percutaneous Approach, Diagnostic |
0GBG3ZX |
Excision of Thyroid Gland Lobe, Left, Percutaneous Approach, Diagnostic |
0GBH3ZX |
Excision of Thyroid Gland Lobe, Right, Percutaneous Approach, Diagnostic |
0B9_3ZX |
Drainage of Fluids and/or Gases from Respiratory System, Percutaneous Approach, Diagnostic |
0BB_3ZX |
Excision of Respiratory System, Percutaneous Approach, Diagnostic |
0W9C3ZX |
Drainage of Fluids and/or Gases Mediastinum, Percutaneous Approach, Diagnostic |
0WBC3ZX |
Excision of Mediastinum, Percutaneous Approach, Diagnostic |
079_3ZX |
Drainage of Fluids and/or Gases from Lymphatic and Hemic Systems, Percutaneous Approach, Diagnostic |
07B_3ZX |
Excision of Lymphatic and Hemic Systems, Percutaneous Approach, Diagnostic |
0F903ZX |
Drainage of Fluids and/or Gases from Liver, Percutaneous Approach, Diagnostic |
0F913ZX |
Drainage of Fluids and/or Gases from Liver, Right Lobe, Percutaneous Approach, Diagnostic |
0F923ZX |
Drainage of Fluids and/or Gases from Liver, Left Lobe, Percutaneous Approach, Diagnostic |
0F9G3ZX |
Drainage of Fluids and/or Gases from Pancreas, Percutaneous Approach, Diagnostic |
0FB03ZX |
Excision of Liver, Percutaneous Approach, Diagnostic |
0FB13ZX |
Excision of Liver, Right Lobe, Percutaneous Approach, Diagnostic |
0FB23ZX |
Excision of Liver, Left Lobe, Percutaneous Approach, Diagnostic |
0FBD3ZX |
Excision of Pancreatic Duct, Percutaneous Approach, Diagnostic |
0FBF3ZX |
Excision of Pancreatic Duct, Accessory, Percutaneous Approach, Diagnostic |
0FBG3ZX |
Excision of Pancreas, Percutaneous Approach, Diagnostic |
0WBF3ZX |
Excision of Abdominal Wall, Percutaneous Approach, Diagnostic |
0WBH3ZX |
Excision of Retroperitoneum, Percutaneous Approach, Diagnostic |
0DBW3ZX |
Excision of Peritoneum, Percutaneous Approach, Diagnostic |
0T903ZX |
Drainage of Fluids and/or Gases from Kidney, Right, Percutaneous Approach, Diagnostic |
0T913ZX |
Drainage of Fluids and/or Gases from Kidney, Left, Percutaneous Approach, Diagnostic |
0T933ZX |
Drainage of Fluids and/or Gases from Kidney Pelvis, Right, Percutaneous Approach, Diagnostic |
0T943ZX |
Drainage of Fluids and/or Gases from Kidney Pelvis, Left, Percutaneous Approach, Diagnostic |
0TB03ZX |
Excision of Kidney, Right, Percutaneous Approach, Diagnostic |
0TB13ZX |
Excision of Kidney, Left, Percutaneous Approach, Diagnostic |
0TB33ZX |
Excision of Kidney Pelvis, Right, Percutaneous Approach, Diagnostic |
0TB43ZX |
Excision of Kidney Pelvis, Left, Percutaneous Approach, Diagnostic |
0V903ZX |
Drainage of Fluids and/or Gases from Prostate, Percutaneous Approach, Diagnostic |
0VB03ZX |
Excision of Prostate, Percutaneous Approach, Diagnostic |
0KB_3ZX |
Excision of Muscles, Percutaneous Approach, Diagnostic |
MS-DRG5 |
Description |
423 |
Other Hepatobiliary or Pancreas Procedures with MCC |
424 |
Other Hepatobiliary or Pancreas Procedures with CC |
425 |
Other Hepatobiliary or Pancreas Procedures without CC/MCC |
500 |
Soft Tissue Procedures with MCC |
501 |
Soft Tissue Procedures with CC |
502 |
Soft Tissue Procedures without CC/MCC |
579 |
Other Skin, Subcutaneous Tissue and Breast Procedures with MCC |
580 |
Other Skin, Subcutaneous Tissue and Breast Procedures with CC |
581 |
Other Skin, Subcutaneous Tissue and Breast Procedures without |
673 |
Other Kidney and Urinary Tract Procedures with MCC |
674 |
Other Kidney and Urinary Tract Procedures with CC |
675 |
Other Kidney and Urinary Tract Procedures without CC/MCC |
Transjugular Liver Biopsy Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
Transcatheter biopsy |
||||||
37200 |
Transcatheter biopsy |
$227.36 |
$227.36 |
5184 |
$4,596.19 |
$2,321.81 |
75970 |
Transcatheter biopsy, radiological supervision and interpretation |
$0 |
$0 |
N/A |
N/A |
Packaged |
Catheter Placement |
||||||
36011 |
Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) |
$890.33 |
$164.93 |
N/A |
N/A |
Packaged |
ICD-10-PCS4 |
Procedure Description |
0F903ZX |
Drainage of Fluids and/or Gases from Liver, Percutaneous Approach, Diagnostic |
0F913ZX |
Drainage of Fluids and/or Gases from Liver, Right Lobe, Percutaneous Approach, Diagnostic |
0F923ZX |
Drainage of Fluids and/or Gases from Liver, Left Lobe, Percutaneous Approach, Diagnostic |
0FB03ZX |
Excision of Liver, Percutaneous Approach, Diagnostic |
0FB13ZX |
Excision of Liver, Right Lobe, Percutaneous Approach, Diagnostic |
0FB23ZX |
Excision of Liver, Left Lobe, Percutaneous Approach, Diagnostic |
C-Code6 |
Description |
C1887 |
Catheter, guiding |
C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
Bone Biopsy Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
20220 |
Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) |
$254.07 |
$92.03 |
5072 |
$1,372.60 |
$576.39 |
20225 |
Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) |
$430.19 |
$137.14 |
5072 |
$1,372.60 |
$576.39 |
38220 |
Diagnostic bone marrow; aspiration(s) |
$172.15 |
$72.54 |
5072 |
$1,372.60 |
$122.34 |
38221 |
Diagnostic bone marrow; biopsy(ies) |
$161.32 |
$72.18 |
5072 |
$1,372.60 |
$111.88 |
38222 |
Diagnostic bone marrow; biopsy(ies) and aspiration(s) |
$178.28 |
$80.84 |
N/A |
N/A |
$994.34 |
ICD-10-PCS4 |
Description |
079T3ZX |
Drainage of Fluids and/or Gas from Bone Marrow, Percutaneous Approach, Diagnostic |
079T3ZZ |
Drainage of Fluids and/or Gas from Bone Marrow, Percutaneous Approach |
07DQ3ZX |
Extraction from Bone Marrow, Sternum, Percutaneous Approach, Diagnostic |
07DQ3ZZ |
Extraction from Bone Marrow, Sternum, Percutaneous Approach |
07DR3ZX |
Extraction from Bone Marrow, Iliac, Percutaneous Approach, Diagnostic |
07DR3ZZ |
Extraction from Bone Marrow, Iliac, Percutaneous Approach |
07DS3ZX |
Extraction from Bone Marrow, Vertebral, Percutaneous Approach, Diagnostic |
07DS3ZZ |
Extraction from Bone Marrow, Vertebral, Percutaneous Approach |
0PB03ZX |
Excision of Sternum, Percutaneous Approach, Diagnostic |
0QB03ZX |
Excision of Lumbar Vertebra, Percutaneous Approach, Diagnostic |
0QB13ZX |
Excision of Sacrum, Percutaneous Approach, Diagnostic |
0QB23ZX |
Excision of Right Pelvic Bone, Percutaneous Approach, Diagnostic |
0QB33ZX |
Excision of Left Pelvic Bone, Percutaneous Approach, Diagnostic |
MS-DRG5 |
Description |
579 |
Biopsies of Musculoskeletal Tissue and Connective Tissue with MCC |
580 |
Biopsies of Musculoskeletal Tissue and Connective Tissue with CC |
581 |
Biopsies of Musculoskeletal Tissue and Connective Tissue without CC/MCC |
C-Code6 |
Description |
G0364 |
Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service |
Drainage Coding & Reimbursement Information
CPT |
Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
Pleural Drainage |
||||||
32554 |
Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance |
$228.45 |
$93.47 |
5181 |
$630.51 |
$318.59 |
32555 |
Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance |
$319 |
$116 |
5181 |
$630.51 |
$318.59 |
32556 |
Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance |
$687 |
$128 |
5302 |
$1,557.40 |
$663.06 |
32557 |
Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance |
$633.37 |
$158.79 |
5182 |
$1,631.13 |
$579.91 |
Biliary Drainage |
||||||
47533 |
Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external |
$1292.01 |
$278.61 |
5341 |
$3,109.34 |
$1,377.21 |
47534 |
Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external |
$1,468.49 |
$388.68 |
5341 |
$3,109.34 |
$1,377.21 |
47535 |
Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation |
$1,017.37 |
$204.99 |
5341 |
$3,109.34 |
$1,377.21 |
47536 |
Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation |
$716.38 |
$138.58 |
5341 |
$3,109.34 |
$1,377.21 |
47537 |
Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation |
$462.31 |
$100.69 |
5301 |
$785.92 |
$397.12 |
Peritoneal Drainage |
||||||
49082 |
Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance |
$210.04 |
$77.23 |
5301 |
$785.92 |
$397.12 |
49083 |
Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance |
$308.93 |
$112.24 |
5301 |
$785.92 |
$397.12 |
49406 |
Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous |
$906.93 |
$205.71 |
5072 |
$1,372.60 |
$576.39 |
49407 |
Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal |
$745.25 |
$218.34 |
5072 |
$1,372.60 |
$576.39 |
Nephrostomy Drainage |
||||||
50432 |
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation |
$913.07 |
$215.09 |
5373 |
$1,771.55 |
$789.71 |
50435 |
Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation |
$578.52 |
$103.94 |
5373 |
$1,771.55 |
$789.71 |
Other Drainage |
||||||
49405 |
Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous |
$907.29 |
$206.07 |
5072 |
$1,372.60 |
N/A |
75984 |
Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation |
$100.69 |
$100.69 |
N/A |
N/A |
Packaged |
75989 |
Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation |
$123.79 |
$123.79 |
N/A |
N/A |
Packaged |
ICD-10-PCS4 |
Description |
0W993ZZ |
Drainage of Fluids and/or Gases from Pleural Cavity, Right, Percutaneous Approach |
0W993ZX |
Drainage of Fluids and/or Gases from Pleural Cavity, Right, Percutaneous Approach, Diagnostic |
0W9930Z |
Drainage of Fluids and/or Gases with Drainage Device from Pleural Cavity, Right, Percutaneous Approach |
0B9N30Z |
Drainage of Fluids and/or Gases with Drainage Device from Pleura, Right, Percutaneous Approach |
0W9B3ZZ |
Drainage of Fluids and/or Gases from Pleural Cavity, Left, Percutaneous Approach |
0W9B3ZX |
Drainage of Fluids and/or Gases from Pleural Cavity, Left, Percutaneous Approach, Diagnostic |
0W9B30Z |
Drainage of Fluids and/or Gases with Drainage Device from Pleural Cavity, Left, Percutaneous Approach |
0B9P30Z |
Drainage of Fluids and/or Gases with Drainage Device from Pleura, Left, Percutaneous Approach |
0W9F3ZZ |
Drainage of Fluids and/or Gases from Abdominal Wall, Percutaneous Approach |
0W9F30Z |
Drainage of Fluids and/or Gases from Abdominal Wall with Drainage Device, Percutaneous Approach |
0W9G3ZZ |
Drainage of Fluids and/or Gases from Peritoneal Cavity, Percutaneous Approach |
0W9G30Z |
Drainage of Fluids and/or Gases from Peritoneal Cavity with Drainage Device, Percutaneous Approach |
0W9G3ZX |
Drainage of Fluids and/or Gases from Peritoneal Cavity with Drainage Device, Percutaneous Approach, Diagnostic |
0F9_30Z |
Drainage of Fluids and/or Gases from Hepatobiliary System and Pancreas with Drainage Device, Percutaneous Approach |
0F2BX0Z |
Change Drainage Device in Hepatobiliary Duct, External Approach |
0FWB30Z |
Revision of Drainage Device in Hepatobiliary Duct, Percutaneous Approach |
0FPB30Z |
Removal of Drainage Device from Hepatobiliary Duct, Percutaneous Approach |
0F7_3DZ |
Dilation of Hepatobiliary System and Pancreas with Intraluminal Device, Percutaneous Approach |
0T9030Z |
Drainage of Fluids and/or Gases with Drainage Device from Kidney, Right, Percutaneous Approach |
0T9130Z |
Drainage of Fluids and/or Gases with Drainage Device from Kidney, Left, Percutaneous Approach |
0T9330Z |
Drainage of Fluids and/or Gases with Drainage Device from Kidney Pelvis, Right, Percutaneous Approach |
0T9430Z |
Drainage of Fluids and/or Gases with Drainage Device from Kidney Pelvis, Left, Percutaneous Approach |
0T25X0Z |
Change Drainage Device in Kidney, External Approach |
MS-DRG5 |
Description |
405 |
Pancreas, Liver and Shunt Procedures with MCC |
406 |
Pancreas, Liver and Shunt Procedures with CC |
407 |
Pancreas, Liver and Shunt Procedures without CC/MCC |
408 |
Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with MCC |
409 |
Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with CC |
410 |
Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. without CC/MCC |
444 |
Disorders of Biliary Tract with MCC |
445 |
Disorders of Biliary Tract with CC |
446 |
Disorders of Biliary Tract without CC/MCC |
C-Code6 |
Description |
C1729 |
Catheter, drainage |
C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
Mammography Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
Breast Biopsy & Breast Localization |
||||||
19081 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance |
$625.79 |
$173.95 |
5072 |
$1,372.60 |
$576.39 |
+19082 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance |
$504.53 |
$87.34 |
N/A |
N/A |
Packaged |
19083 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance |
$619.30 |
$164.57 |
5072 |
$1,372.60 |
$576.39 |
19084 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance |
$490.82 |
$81.20 |
N/A |
N/A |
Packaged |
19085 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance |
$944.83 |
$190.55 |
5072 |
$1,372.60 |
$576.39 |
19086 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance |
$751.02 |
$94.92 |
N/A |
N/A |
Packaged |
Breast Localization Device |
||||||
19281 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance |
$251.54 |
$104.66 |
5071 |
$53.77 |
Packaged |
19282 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance |
$177.56 |
$52.69 |
N/A |
N/A |
Packaged |
19283 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance |
$279.33 |
$105.74 |
5071 |
$53.77 |
Packaged |
19284 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance |
$212.93 |
$53.77 |
N/A |
N/A |
Packaged |
19285 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance |
$468.44 |
$89.86 |
5071 |
$53.77 |
Packaged |
19286 |
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance |
$399.87 |
$45.47 |
N/A |
N/A |
Packaged |
19287 |
Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including Magnetic Resonance guidance |
$797.58 |
$134.25 |
5071 |
$53.77 |
Packaged |
19288 |
Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including Magnetic Resonance guidance |
$634.46 |
$67.49 |
N/A |
N/A |
Packaged |
ICD-10-PCS4 |
Description |
0HBT3ZX |
Excision of Breast, Right, Percutaneous Approach, Diagnostic |
0HBT3ZZ |
Excision of Breast, Right, Percutaneous Approach |
0HBU3ZX |
Excision of Breast, Left, Percutaneous Approach, Diagnostic |
0HBU3ZZ |
Excision of Breast, Left, Percutaneous Approach |
0HBV3ZX |
Excision of Breast, Bilateral, Percutaneous Approach, Diagnostic |
0HBV3ZZ |
Excision of Breast, Bilateral, Percutaneous Approach |
0HJT3ZZ |
Inspection of Breast, Right, Percutaneous Approach |
0HJU3ZZ |
Inspection of Breast, Left, Percutaneous Approach |
MS-DRG5 |
Description |
584 |
Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC |
585 |
Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC |
C-Code6 |
Description |
C1819 |
Surgical tissue localization and excision device (implantable) |
Sonohysterography or Hysterosalpingography Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
58340 |
Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography |
$199.58 |
$59.55 |
N/A |
N/A |
Packaged |
76831 |
Saline infusion sonohysterography (SIS), including color flow Doppler, when performed |
$121.26 |
$121.26 |
5523 |
$233.04 |
$84.09 |
74740 |
Hysterosalpingography, radiological supervision and interpretation |
$91.67 |
$91.67 |
N/A |
N/A |
Packaged |
ICD-10-PCS4 |
Description |
0UJD3ZZ |
Inspection of Uterus and Cervix, Percutaneous Approach |
C-Code6 |
Description |
C2628 |
Catheter, occlusion |
Endomyocardial Biopsy Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
93505 |
Endomyocardial biopsy |
$727.57 |
$727.57 |
5183 |
$2,771.28 |
N/A |
ICD-10-PCS4 |
Description |
02BK3ZX |
Excision of Ventricle, Right, Percutaneous Approach, Diagnostic |
02BL3ZX |
Excision of Ventricle, Left, Percutaneous Approach, Diagnostic |
Hemodialysis Coding & Reimbursement Information
CPT |
Procedure Description |
Physician Fee1 |
APC2 |
ASC |
||
Non-Facility |
Facility |
Code |
Payment |
|||
36558 |
Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older |
$836.20 |
$272.48 |
5183 |
$2,771.28 |
$1,341.23 |
36581 |
Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access |
$826.81 |
$191.27 |
5183 |
$2,771.28 |
$1,341.23 |
36589 |
Removal of tunneled central venous catheter, without subcutaneous port or pump |
$171.79 |
$143.28 |
5181 |
$630.51 |
$318.59 |
ICD-10-PCS4 |
Description |
05H533Z |
Insertion of Infusion Device into Subclavian Vein, Right, Percutaneous Approach |
05H633Z |
Insertion of Infusion Device into Subclavian Vein, Left, Percutaneous Approach |
05HM33Z |
Insertion of Infusion Device into Internal Jugular Vein, Right, Percutaneous Approach |
05HN33Z |
Insertion of Infusion Device into Internal Jugular Vein, Left, Percutaneous Approach |
05PY33Z |
Removal of Infusion Device from Upper Vein, Percutaneous Approach |
C-Code6 |
Description |
C1750 |
Catheter, hemodialysis/peritoneal, long-term |
C1752 |
Catheter, hemodialysis/peritoneal, short-term |
MCC: Major Complication or Comorbidity
CC: Complication or Comorbidity
N/A: Not covered or not available
Packaged: Packaged with primary procedure
Reimbursement References:
1 2020 Medicare Physician Services Fee Schedule (Physician) (www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx)
2 2020 Medicare Outpatient Hospital Fee Schedule (APC) (www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1717-cn)
3 2020 Medicare Ambulatory Surgery Center Fee Schedule (ASC) (www.cms.gov/apps/ama/license.asp?file=/files/zip/july-2020-asc-approved-hcpcs-code-and-payment-rates.zip)
4 Procedural codes (PCS) from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) used on hospitalized inpatients. ICD-10-CM comes from the same revision but is specific to clinical modifiers for diagnosing (CM) (www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS)
5 The Medicare Severity Diagnosis Related Groups is a classification system for an inpatient stay based on principal diagnosis, additional diagnoses, and procedures (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software)
6 Unique temporary pricing codes established by the Centers for Medicare and Medicaid Services (CMS) and only valid for Medicare on claims for hospital outpatient department services and procedures (https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/2018-11-30-HCPCS-Level2-Coding-Procedure.pdf)
Disclaimer: Argon Medical Devices, Inc. does not warrant or guarantee that the use of this information will result in coverage or reimbursement for our products at any particular level. Hospitals and physicians are solely responsible for their compliance with Medicare and other payor rules, requirements and for the information submitted with all claims and appeals. Before any claims or appeals are submitted, healthcare providers should review official payor instructions, requirements, and confirm the accuracy of their coding or billing practices with these payors. Hospitals and physicians should use independent judgment when selecting codes that most appropriately describe the services or supplies provided to a patient. The content is not intended to instruct hospitals and/or physicians on how to use medical devices or bill for healthcare procedures.
Argon Medical makes no representation or warranty regarding this information or its completeness or accuracy and will bear no responsibility for the results or consequences of the use of this information.
CPT® is a registered trademark of American Medical Association (AMA). CPT Coding and descriptors are copyrighted by AMA.
Last Updated: August 2020