CMS creates new MS-DRG codes and payments for coronary IVL


Shockwave Medical has announced that as part of the Fiscal Year 2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) has created new Medicare Severity Diagnosis Related Group (MS-DRG) codes and payments for coronary intravascular lithotripsy (IVL) in the hospital inpatient setting. The new MS-DRG codes and payments will become effective 1 October 2023.

Three new codes, MS-DRGs 323, 324, and 325, have been created to describe percutaneous coronary interventions (PCI) that utilise coronary IVL, with and without a stent implant (intraluminal device), in the hospital inpatient setting. The new coronary IVL-specific MS-DRGs are associated with higher payments than the MS-DRG payments for other PCI procedures.

To date, hospitals in the USA have been reimbursed for coronary IVL via a New Technology Add-On Payment (NTAP), which provides an incremental payment of up to US$3,666 in addition to the relevant MS-DRG payment for a PCI procedure performed in a hospital inpatient setting.

The NTAP for coronary IVL will expire on 30 September 2023. CMS analysed the relevant data collected on coronary IVL under the NTAP programme in order to determine how to best code and pay for coronary IVL going forward. CMS first proposed these new MS-DRGs in April via the Fiscal Year 2024 Proposed IPPS, which, following a 60-day public comment period, has now been finalised.

“We appreciate CMS’ decision to create new MS-DRGs for coronary IVL. We believe these new MS-DRGs, which are the first new additions in the field of PCI in over 20 years, will help ensure access to the safe and effective benefits of Shockwave IVL for patients suffering from complex, calcified coronary artery disease,” said Robert Fletcher, senior vice president of marketing and market access at Shockwave Medical. “Having appropriate reimbursement for hospitals is key to ensuring that physicians are able to choose the optimal calcium modification strategy for patients undergoing a PCI. We would like to acknowledge CMS for their thorough evaluation of the NTAP programme for coronary IVL and for their thoughtful conclusion on a permanent reimbursement structure.”


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