F E B R U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 1 9
CMS added 17 cardiac diagnostic
procedures to the ASC-
approved list last year, which
has paved the way for six
new stent-related inter-
vention procedure codes
(CPT codes 92920, 92921,
92928, 92929, C9600,
C9601) in 2020.
In 2016, according to data
in the Medicare Provider Access and Review (MEDPAR) file,
Medicare beneficiaries underwent more than 523,000 cardiac
catheterizations on an outpatient basis in hospitals, resulting in
an estimated $682 million in payments, according to Ronald
Hirsch, vice president of regulations and education for R1 RCM's
Physicians Advisory Solutions, a consulting firm based in
Chicago, Ill.
In 2020, CMS will reimburse hospital outpatient departments
$2,899 and ASCs $1,377 for a cardiac catheterization procedure.
For a cardiac catheterization with a stent, the proposed rate is
$10,013 for HOPDs and $6,203 for ASCs. On average, eight to 10
stent procedures can be performed in one operating room each
day. The cost per case is approximately $2,000, so an
HOPD would make about $8,000 and an ASC would make about
$4,200 for each procedure performed.
— Adam Taylor
PIECE OF THE PIE
Preview of Payment Rates
