Please find below the relevant reimbursement information for LC Bead LUMITM:

Hepatic Embolization


Hospital Inpatient

DRG Description Medicare
435 Malignancy of hepotobiliary system or pancreas with MCC $10,319.12
436 Malignancy of hepotobiliary system or pancreas with CC $6,900.28
437 Malignancy of hepotobiliary system or pancreas with CC $5,344.38
 

Hospital Outpatient

CPT-4® Description SI APC Medicare
36247 Selective catheter placement, arterial system, initial third order abdominal, pelvic, lower extremity artery branch within vascular family N N/A Packaged
36248 Additional second order, third order, and beyond N N/A Packaged
37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural oadmapping, and imaging guidance necessary to complete the intervention; for tumours, organ iscemia, or infarction. J1 5192 $9,542.35
75726 Angiography, visceral, selective or superselective (with or without flush aortogram), radiological and supervision and interpretation. Q2 5526 $2,718.83 or Packaged
75774 Angiography, selective, each additional vessel studied after basic examination, RS&I. N N/A Packaged
75898 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion. Q2 5525 $667.93 or Packaged
 

Physician Profesional

CPT-4® Description Modifier Medicare
36247 Selective catheter placement, arterial system, initial third order abdominal, pelvic, or lower extremity artery branch within vascular family.   $332.62
36248 Additional second order, third order, and beyond.   $51.92
37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction.   $610.11
75726 Angiography, visceral, selective or superselective (with ot without flush aortogram), RS&I. 26 $56.57
75774 Angiography, visceral, each additional vessel studied after basic examination, RS&I. 26 $17.90
75894 Transcatheter therapy, embolization, any method, RS&I. 26 $67.67
75898 Angiography through existying catheter for follow-up study for transcatheter therapy, embolization or infusion. 26 $85.93
 

Renal Embolization

 

Hospital Inpatient

DRG Description Medicare
673 Other Kidney and Urinary Tract procedure with MCC. $19,815.72
674 Other Kidney and Urinary Tract procedure with CC. $13,668.29
675 Other Kidney and Urinary Tract procedure without MCC/CC. $9,208.44
 

Hospital Outpatient

CPT-4® Description SI APC Medicare
36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiograph; unilateral. Q2 5526 $2,718.83 or Packaged
36252 Bilateral. Q2 5526 $2,718.83 or Packaged
36253 Superselective catheter placement renal artery and any accessory renal artery(s) for renal angiography; unilateral. Q2 5526 $2,718.83 or Packaged
36254 Bilateral. Q2 5526 $2,718.83 or Packaged
37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction. J1 5192 $9,542.35
75898 Angiography throughexisting catheter for follow-up syudy for transcatheter therapy; embolization or infusion. Q2 5525 $667.93 or Packaged
 

Physician Profesional

CPT-4® Description Medicare
36251 Selectivecatheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, unuilateral. $294.31
36252 Bilateral. $392.06
36253 Superselective catheter placement renal artery and any accessory renal artery(s) for renal angiography; unilateral. $394.21
36254 Bilateral. $455.43
37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction. $610.11
75898-26 Angiography through existing catheter for follow-up study for trancatheter therapy, embolization or infusion. $85.93

For reimbursement support please contact:
lcbead@thepinnaclehealthgroup.com or 866-369-9290

Notes:

DRG values calculated using a base rate of $5466.09 and Capital Standard Payment of $438.65. The national average hospital Medicare base rate is the sum of the full update labor-related and nonlabor-related amount published in the Federal Register, FY 2016 IPPS Final Rule (Tables 1A, 1D, and 5).

CPT - AMA Procedure Code indicating what procedure was performed.

Description - Describes the procedure performed.

SI – The SI (Status Indicator) assigned by CMS to each code to indicate its payment status.

APC - The APC (Ambulatory Payment Category) assigned by CMS based upon the procedure performed.

APC National Value - Indicates the national average payment rate for the APC

J1 - Comprehensive APC; all services reported on claim will be packaged with payment for J1 procedure except
services with an F, G, H, L, and U status indicator.

N - Payment is packaged with the primary procedure.

Q2 - Packaged if billed on the same date of service as a HCPCS code assigned a status indicator “T”.

MPR - Multiple Procedure Rule discounting will apply to CPT codes listed under Physician Professional services.