Shockwave Announces New CMS Codes and Increased Payments for Coronary Intravascular Lithotripsy

August 2, 2023—Shockwave Medical, Inc., a developer of intravascular lithotripsy (IVL) technology to treat severely calcified cardiovascular disease, announced that the Centers for Medicare & Medicaid Services (CMS) created a new Medicare Severity Diagnosis Related Group (MS-DRG) codes and payments for coronary IVL in the hospital inpatient setting. The codes are part of the FY2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule.

The new MS-DRG codes and payments will become effective on October 1, 2023.

Three new codes have been created to describe percutaneous coronary interventions (PCI) that utilize 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, advised the company.

The relevant codes and approximate payments are: 

• MS-DRG 323 for coronary IVL with an intraluminal device with major complications and comorbidities (MCC); payment, $28,987 
• MS-DRG 324 for coronary IVL with intraluminal device without MCC; payment, $20,785
• MS-DRG 325 for coronary IVL without intraluminal device without CC/MCC; payment, $18,514

According to Shockwave, hospitals in the United States have been reimbursed for coronary IVL via a New Technology Add-On Payment (NTAP), which provides an incremental payment of up to $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 September 30, 2023.

In keeping with the procedure, CMS analyzed the relevant data collected on coronary IVL under the NTAP program to determine how to best code and pay for coronary IVL going forward. CMS first proposed these new MS-DRGs in April via the FY2024 Proposed IPPS, which, following a 60-day public comment period, has now been finalized.

In the company’s press release, Robert Fletcher, Senior Vice President of Marketing and Market Access at Shockwave Medical, states, “We appreciate CMS’s 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.”

Fletcher added, “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 program for coronary IVL and for their thoughtful conclusion on a permanent reimbursement structure.”