Cardiac Resynchronization Therapy - ASC Payment details for CY 2012

Effective for services furnished on or after January 1, 2012, cardiac resynchronization therapy involving an implantable cardioverter defibrillator (CRT-D) will be recognized as a single, composite service combining implantable cardioverter defibrillator procedures (described by Current Procedural Terminology (CPT) code 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator)) and pacing electrode insertion procedures (described by CPT code 33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system))) when performed on the same Date of Service in an ASC.

The payment rate for CRT-D services in ASCs will be based on the OPPS payment rate applicable to APC 0108 and ASCs will use the HCPCS Level II G-code G0448 (Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s) single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing) for proper reporting when the procedures described by CPT codes 33225 and 33249 are performed on the same Date of Service. When these procedures are not performed on the same Date of Service, the ASC payment rate will be based on the standard APC assignment for each service and ASCs should report the appropriate CPT codes for the individual procedures.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7682.pdf

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