Increased Hospital Inpatient Reimbursement for Shockwave IVL
Fiscal Year 2025 (FY2025) Medicare Inpatient Prospective Payment System (IPPS) final rule increases payments for hospital inpatient Coronary and Peripheral IVL procedures
The IPPS FY2025 final rule contains several payment updates for hospital inpatient coronary and peripheral procedures effective October 1, 2024. Please see below for more information.
FY2025 Payment Updates for Coronary IVL
The final FY2025 Medicare base payment rates for hospital inpatient Coronary IVL and standard PCI procedures are described in the table below. As compared to the previous year, payments associated with Coronary IVL MS-DRGs have increased by ~$2K and the incremental payment between standard PCI and Coronary IVL with stent procedures has increased to ~$10,000. PCI with stent procedures utilizing alternative plaque modification therapies such as atherectomy, cutting or scoring balloons without the adjunctive use of Coronary IVL will map to PCI MS-DRGs 321-322. Please see the tables below for more information.
FY2025 Payment Updates for Peripheral IVL
The FY2025 final IPPS rule also contains payment updates for peripheral interventions. As compared to the prior year, the new rates associated with the Peripheral IVL MS-DRGs 278 & 279 result in a national base payment increase of $4,376 for patients with MCC1 and $395 for patients with CC/none1. In addition, the incremental payment between the Peripheral Procedures MS-DRG 250 series, which includes PTA, DCB, Stents (Covered, BMS, DES), and Peripheral IVL MS-DRGs 278 & 279 ranges from ~$4,600 to ~$11,000** as shown in the tables below.
** When peripheral procedures include peripheral atherectomy, MS-DRGs 270, 271, and 272 may be used.
1. MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities.
- 2. CMS-1808-F; National Average MS-DRG rates shown are based on Medicare Inpatient Prospective Payment System FY2025 Final Rule, Table 1 & Table 5. National average payment rates assume full update amount for hospitals which have submitted quality data and hospitals have a wage index greater than 1. Site specific payment rates will vary based on regional area wage differences, teaching hospital status, indirect medical education costs, quality data, additional payments to hospitals that treat a large percentage of low-income patients (“disproportionate share payments”), etc.
The coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. Shockwave Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies.
In the US: Rx only - Prior to use, please reference the Important Safety Information www.shockwavemedical.com/IFU for more information on indications, contraindications, warnings, precautions and adverse events.
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