The information contained in this document, including the codes supplied, is provided for informational purposes only. BD makes no statement, promise or guarantee concerning the appropriateness of any codes for a particular procedure, actual levels of reimbursement, payment or charge or that reimbursement will be made. This is not intended to be a comprehensive guide to all coding and payment information.
Reimbursement rates shown are Medicare national payments for 2019 and do not reflect actual payments made to individual providers, as payments are adjusted specific to particular geographic regions.
All information is subject to change without notice. In addition, payers or local carriers may have their own coding and billing requirements. Consult your payer organization with regard to local reimbursement policies
2019 Medicare outpatient facility rates
CPT® code Description APC Status 2019 APC OPPS base rate* 2019 ASC base rate
Pleural catheter procedures
32550 Insertion of indwelling tunneled pleural catheter 5341 J1 $2,947 $1,790
32552 Removal of indwelling tunneled pleural catheter with cuff 5181 Q2 $620 $319
32560 Instillation via chest tube/catheter, agent for pleurodesis 5181 T $620 N/A
32650 Thoracoscopy, surgical, with pleurodesis (e.g., mechanical or chemical) N/A; inpatient procedure
Peritoneal catheter procedures
49418
Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites),
complete procedure, including imaging guidance, catheter placement, contrast injection when performed and radiological
supervision and interpretation, percutaneous
5341 J1 $2,947 $1,343
49422 Removal of tunneled intraperitoneal catheter 5183 Q2 $2,642 $1,305
Shunt procedures
49425 Insertion of peritoneal-venous shunt N/A; inpatient procedure
49426 Revision of peritoneal-venous shunt 5341 J1 $2,947 $1,343
49429 Removal of peritoneal-venous shunt 5183 Q2 $2,642 $1,305
49999 Unlisted procedure, abdomen, peritoneum and omentum (report this code for Denver™ Pleuroperitoneal Shunt procedures) 5301 T $762 N/A
Drainage procedures
32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance 5181 T $620 $319
32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance 5181 T $620 $319
32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance 5302 J1 $1,483 $642
32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance 5182 T $1,094 $563
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance 5301 T $762 $392
49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance 5301 T $762 $392
Guidance
75989 Radiological guidance (i.e., fluoroscopy, ultrasound or computed tomography), for percutaneous drainage
(e.g., abscess, specimen collection), with placement of catheter, radiological supervision and interpretation N/A N Packaged Packaged
77002 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) N/A N Packaged Packaged
77012 Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device),
radiological supervision and interpretation N/A N Packaged Packaged
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation N/A N Packaged Packaged
Status indicator definitions HCPCS device codes
J1: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F, G, H, L
and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.
T: Significant procedure, multiple reduction applies.
Q2: Items and services packaged into APC rates.
C1729 Catheter, drainage
C1894 Introducers/sheath
C1769 Guidewire
2019 Medicare physician rates
CPT code Description Work RVUs 2019 physician facility rate 2019 physician non-facility rate
Pleural catheter procedures
32550 Insertion of indwelling tunneled pleural catheter 3.92 $216 $767
32552 Removal of indwelling tunneled pleural catheter with cuff 2.53 $164 $190
32560 Instillation via chest tube/catheter, agent for pleurodesis 1.54 $81 $258
32650 Thoracoscopy, surgical, with pleurodesis (e.g., mechanical or chemical) 10.83 $692 N/A
Peritoneal catheter procedures
49418
Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management
of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed
and radiological supervision and interpretation, percutaneous
3.96 $212 $1,302
49422 Removal of permanent intraperitoneal cannula or catheter 4.00 $233 N/A
Shunt procedures
49425 Insertion of peritoneal-venous shunt 12.22 $751 N/A
49426 Revision of peritoneal-venous shunt 10.41 $644 N/A
49429 Removal of peritoneal-venous shunt 7.44 $479 N/A
49999 Unlisted procedure, abdomen, peritoneum and omentum (report this code for Denver™ Pleuroperitoneal Shunt procedures) N/A Carrier-priced Carrier-priced
Drainage procedures
32554 Thoracentesis; needle or catheter; aspiration of the pleural space; without imaging guidance 1.82 $93 $217
32555 Thoracentesis; needle or catheter; aspiration of the pleural space; with imaging guidance 2.27 $116 $307
32556 Pleural drainage; percutaneous; with insertion of indwelling catheter; without imaging guidance 2.50 $128 $627
32557 Pleural drainage; percutaneous; with insertion of indwelling catheter; with imaging guidance 3.12 $158 $578
49082 Abdominal paracentesis (diagnostic or therapeutic); without image guidance 1.24 $76 $204
49083 Abdominal paracentesis (diagnostic or therapeutic); with image guidance 2.00 $112 $304
Guidance With –26 modifier
75989 Radiological guidance (i.e., fluoroscopy, ultrasound or computed tomography), for percutaneous drainage
(e.g., abscess, specimen collection), with placement of catheter, radiological supervision and interpretation 1.19 $59 $123
Reimbursement rates shown are Medicare national payments for 2019 and do not reflect actual payments made to individual providers, as payments are adjusted specific to particular geographic regions.
All information is subject to change without notice. In addition, payers or local carriers may have their own coding and billing requirements. Consult your payer organization with regard to local reimbursement policies
2019 Medicare outpatient facility rates
CPT® code Description APC Status 2019 APC OPPS base rate* 2019 ASC base rate
Pleural catheter procedures
32550 Insertion of indwelling tunneled pleural catheter 5341 J1 $2,947 $1,790
32552 Removal of indwelling tunneled pleural catheter with cuff 5181 Q2 $620 $319
32560 Instillation via chest tube/catheter, agent for pleurodesis 5181 T $620 N/A
32650 Thoracoscopy, surgical, with pleurodesis (e.g., mechanical or chemical) N/A; inpatient procedure
Peritoneal catheter procedures
49418
Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites),
complete procedure, including imaging guidance, catheter placement, contrast injection when performed and radiological
supervision and interpretation, percutaneous
5341 J1 $2,947 $1,343
49422 Removal of tunneled intraperitoneal catheter 5183 Q2 $2,642 $1,305
Shunt procedures
49425 Insertion of peritoneal-venous shunt N/A; inpatient procedure
49426 Revision of peritoneal-venous shunt 5341 J1 $2,947 $1,343
49429 Removal of peritoneal-venous shunt 5183 Q2 $2,642 $1,305
49999 Unlisted procedure, abdomen, peritoneum and omentum (report this code for Denver™ Pleuroperitoneal Shunt procedures) 5301 T $762 N/A
Drainage procedures
32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance 5181 T $620 $319
32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance 5181 T $620 $319
32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance 5302 J1 $1,483 $642
32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance 5182 T $1,094 $563
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance 5301 T $762 $392
49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance 5301 T $762 $392
Guidance
75989 Radiological guidance (i.e., fluoroscopy, ultrasound or computed tomography), for percutaneous drainage
(e.g., abscess, specimen collection), with placement of catheter, radiological supervision and interpretation N/A N Packaged Packaged
77002 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) N/A N Packaged Packaged
77012 Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device),
radiological supervision and interpretation N/A N Packaged Packaged
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation N/A N Packaged Packaged
Status indicator definitions HCPCS device codes
J1: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F, G, H, L
and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.
T: Significant procedure, multiple reduction applies.
Q2: Items and services packaged into APC rates.
C1729 Catheter, drainage
C1894 Introducers/sheath
C1769 Guidewire
2019 Medicare physician rates
CPT code Description Work RVUs 2019 physician facility rate 2019 physician non-facility rate
Pleural catheter procedures
32550 Insertion of indwelling tunneled pleural catheter 3.92 $216 $767
32552 Removal of indwelling tunneled pleural catheter with cuff 2.53 $164 $190
32560 Instillation via chest tube/catheter, agent for pleurodesis 1.54 $81 $258
32650 Thoracoscopy, surgical, with pleurodesis (e.g., mechanical or chemical) 10.83 $692 N/A
Peritoneal catheter procedures
49418
Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management
of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed
and radiological supervision and interpretation, percutaneous
3.96 $212 $1,302
49422 Removal of permanent intraperitoneal cannula or catheter 4.00 $233 N/A
Shunt procedures
49425 Insertion of peritoneal-venous shunt 12.22 $751 N/A
49426 Revision of peritoneal-venous shunt 10.41 $644 N/A
49429 Removal of peritoneal-venous shunt 7.44 $479 N/A
49999 Unlisted procedure, abdomen, peritoneum and omentum (report this code for Denver™ Pleuroperitoneal Shunt procedures) N/A Carrier-priced Carrier-priced
Drainage procedures
32554 Thoracentesis; needle or catheter; aspiration of the pleural space; without imaging guidance 1.82 $93 $217
32555 Thoracentesis; needle or catheter; aspiration of the pleural space; with imaging guidance 2.27 $116 $307
32556 Pleural drainage; percutaneous; with insertion of indwelling catheter; without imaging guidance 2.50 $128 $627
32557 Pleural drainage; percutaneous; with insertion of indwelling catheter; with imaging guidance 3.12 $158 $578
49082 Abdominal paracentesis (diagnostic or therapeutic); without image guidance 1.24 $76 $204
49083 Abdominal paracentesis (diagnostic or therapeutic); with image guidance 2.00 $112 $304
Guidance With –26 modifier
75989 Radiological guidance (i.e., fluoroscopy, ultrasound or computed tomography), for percutaneous drainage
(e.g., abscess, specimen collection), with placement of catheter, radiological supervision and interpretation 1.19 $59 $123
This post first appeared on Interventional Radiology Medical Coding - Learn How To Code, please read the originial post: here
