Bard Biopsy 2016 Medicare Final Rule National Average Payments

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1 Biopsy Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic $676 $ % $174 $ % $1,052 $ % $577 $ % each additional lesion, including stereotactic (List separately in addition to code for primary procedure) (Use in conjunction with 19081) $552 $ % $84 $88 4.8% packaged packaged packaged packaged Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound $660 $ % $170 $ % $1,052 $ % $577 $ % Breast Biopsy, Local Excision and Other Breast s with CC/MCC $10,371 $9, % each additional lesion, including ultrasound (List separately in addition to code for primary procedure) (Use in conjunction with 19083) $532 $ % $80 $82 2.5% packaged packaged packaged packaged Breast Biopsy, Local Excision and Other Breast s without CC/MCC $8,066 $8, % Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance $1,058 $1, % $222 $ % $1,052 $1, % $577 $ % each additional lesion, including magnetic resonance (List separately in addition to code for primary procedure) (Use in conjunction with 19085) (Do not report in conjunction with , 76098,,, for same lesion) $832 $ % $97 $96-1.0% packaged packaged packaged packaged Biopsy of breast; open, incisional $345 $ % $225 $ % $2,167 $2, % $1,188 $1, % Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion $554 $ % $467 $ % $2,167 $2, % $1,188 $1, % Inclusive to main procedure DRG Breast Localization radioactive seeds), percutaneous; first lesion, including mammographic $243 $ % $105 $ % $132 $ % $0 $0 radioactive seeds), percutaneous; each additional lesion, including mammographic (List separately in addition to code for primary procedure) $174 $ % $56 $53-5.4% packaged packaged $0 $ radioactive seeds), percutaneous; first lesion, including stereotactic $277 $ % $105 $ % $132 $ % $0 $ radioactive seeds), percutaneous; each additional lesion, including stereotactic (List separately in addition to code for primary procedure) $208 $ % $57 $53-7.0% packaged packaged $0 $ Breast Biopsy, Local Excision and Other Breast s with CC/MCC $10,371 $9, % radioactive seeds), percutaneous; first lesion, including ultrasound $453 $ % $90 $90 0.0% $132 $ % $0 $ radioactive seeds), percutaneous; each additional lesion, including ultrasound (List separately in addition to code for primary procedure) $388 $ % $49 $45-8.2% packaged packaged $0 $0 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance $887 $ % $144 $ % $132 $ % $0 $ Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance (List separately in addition to code for primary procedure) $712 $ % $71 $67-5.6% packaged packaged $0 $ Breast Biopsy, Local Excision and Other Breast s without CC/MCC $8,066 $8, % 1 of 6

2 Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging ; on date separate from partial mastectomy $3,972 $4, % $214 $ % $7,461 $7, % $2,975 $3, % Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging ; concurrent with partial mastectomy (List separately in addition to code for primary procedure) N/A N/A N/A $97 $99 2.1% packaged packaged packaged packaged Other Skin, Subcutaneous Tissue and Breast s with MCC $15,991 $14, % 580-Other Skin, Subcutaneous Tissue and Breast s with CC $9,225 $8, % 581-Other Skin, Subcutaneous Tissue and Breast s without CC/MCC $6,650 $6, % Level IV - Surgical pathology, gross and microscopic examination - Breast, biopsy, not requiring microscopic evaluation of surgical margins; Breast, reduction mammoplasty $73 $74 1.4% $39 $40 2.6% $54 $ % N/A N/A N/A Inclusive to main procedure DRG Pleural Drainage Insert pleural catheter $796 $ % $228 $ % $2,287 $2, % $1,254 $1, % Inclusive to main procedure DRG Peritoneal Drainage Removal of indwelling tunneled pleural catheter with cuff Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging Abdominal paracentesis (diagnostic or therapeutic); without imaging $190 $ % $164 $ % $489 $ % $268 $ % Inclusive to main procedure DRG $204 $ % $92 $93 1.1% $489 $ % $268 $ % Inclusive to main procedure DRG $294 $ % $116 $ % $489 $ % $268 $ % Inclusive to main procedure DRG $564 $ % $127 $ % $489 $1, % $268 $ % Inclusive to main procedure DRG $519 $ % $159 $ % $489 $ % $268 $ % Inclusive to main procedure DRG $197 $ % $77 $77 0.0% $489 $ % $268 $ % 54.25, Inclusive to main procedure DRG Abdominal paracentesis (diagnostic or therapeutic); with imaging Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous $298 $ % $112 $ % $489 $ % $268 $ % 54.25, Inclusive to main procedure DRG $1,458 $1, % $226 $ % $2,287 $2, % $1,254 $1, % Inclusive to main procedure DRG 2 of 6

3 Absscesses/Cysts Removal of tunneled intraperitoneal catheter Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous N/A N/A $390 $ % $1,575 $2, % $864 $1, % Inclusive to main procedure DRG $795 $ % $164 $ % $866 $ % $475 $ % Inclusive to main procedure DRG $891 $ % $221 $ % $1,052 $ % N/A N/A Inclusive to main procedure DRG Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous $892 $ % $221 $ % $1,052 $1, % N/A $791 Payment Restored Inclusive to main procedure DRG Biliary Drainage * NEW CODE FOR * NEW CODE FOR * NEW CODE FOR Exchange of previously placed abscess or cyst drainage catheter under radiological (separate procedure) $559 $ % $75 $75 0.0% $1,289 $1, % $707 $ % Inclusive to main procedure DRG Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external $1,674 $422 $2,177 $1,217 Inclusive to main procedure DRG Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging (eg, fluoroscopy), and all associated radiological supervision and interpretation $828 $153 $2,177 $1,217 Inclusive to main procedure DRG Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging (eg, fluoroscopy), and all associated radiological supervision and interpretation $410 $104 $483 $270 Inclusive to main procedure DRG DELETED FOR Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation Imaging Radiological (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation $122 $ % $60 $59-1.7% packaged packaged packaged packaged Inclusive to main procedure DRG 3 of 6

4 Sentinel Node Biopsy Biopsy or excision of lymph node(s); open, superficial $337 $ % $259 $ % $2,344 $2,188 $1,285 $1, Other Skin, Subcutaneous Tissue and Breast s with MCC $15,991 $14, % 580-Other Skin, Subcutaneous Tissue and Biopsy or excision of lymph node(s); open, deep axillary node(s) N/A N/A $445 $ % $2,344 $2,188 $1,285 $1, Breast s with CC $9,225 $8, % Biopsy or excision of lymph node(s); open, internal mammary node(s) N/A N/A $558 $ % $2,344 $2,188 $1,285 $1, Other Skin, Subcutaneous Tissue and Breast s without CC/MCC $6,650 $6, % Injection procedure; radioactive tracer for identification of sentinel node N/A N/A $41 $40-2.4% $280 $333 packaged packaged Inclusive to main procedure DRG Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) N/A N/A $141 $ % N/A N/A N/A N/A Inclusive to main procedure DRG SOFT TISSUE BIOPSY Thyroid Biopsy thyroid, percutaneous core needle $115 $ % $82 $82 0.0% $487 $ % $54 $54 0.0% Inclusive to main procedure DRG Pleura Lung Biopsy, pleura, percutaneous needle $154 $ % $90 $90 0.0% $1,052 $ % $577 $ % Inclusive to main procedure DRG Biopsy, lung or mediastinum, percutaneous needle $457 $ % $107 $ % $1,052 $ % $577 $ % 33.26, Inclusive to main procedure DRG 4 of 6

5 Lymph Node Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) $129 $ % $74 $74 0.0% $1,052 $ % $577 $ % 40.11, 40.23, Other Skin, Subcutaneous Tissue and Breast s with MCC $15,991 $14, % 580-Other Skin, Subcutaneous Tissue and Breast s with CC $9,225 $8, % 581-Other Skin, Subcutaneous Tissue and Breast s without CC/MCC $6,650 $6, % Liver Retriperitoneum or Abdomen Pancreas Biopsy of liver, needle; percutaneous $370 $ % $107 $ % $1,052 $ % $577 $ % Inclusive to main procedure DRG Biopsy, abdominal or retroperitoneal mass, percutaneous needle $167 $ % $89 $89 0.0% $1,052 $ % $577 $ % Inclusive to main procedure DRG Biopsy of pancreas, percutaneous needle $544 $ % $251 $ % $1,052 $ % $577 $ % Inclusive to main procedure DRG 5 of 6

6 Kidney Renal biopsy; percutaneous, by trocar or needle $624 $ % $147 $ % $1,052 $1, % $577 $ % Inclusive to main procedure DRG Prostate Biopsy, prostate; needle or punch, single or multiple, any approach $220 $ % $142 $ % $1,462 $1, % $802 $ % Inclusive to main procedure DRG Prostate Saturation Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging N/A N/A N/A $380 $ % $1,462 $2, % $802 $1, % Inclusive to main procedure DRG Muscle, Soft Tissue Biopsy, muscle, percutaneous needle $240 $ % $61 $61 0.0% $1,052 $ % $577 $ % Inclusive to main procedure DRG ICD-10 Weblink: Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets will replace ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at American Medical Association's "Physician's Current Procedural Terminology 2015, DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 412, 413, 416, and 419, [CMS-1633-FC; CMS-1607-F2], RIN 0938-AS42; RIN 0938-AS11; Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals under the Hospital Prospective Payment System; Provider Administrative Appeals and Judicial Review DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 411, 414, 425, and 495, [CMS-1631-FC], RIN 0938-AS40; Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016 DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services,42 CFR Part 412, [CMS-1632-F and IFC], RIN-0938-AS41; Medicare Program; Hospital Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals World Health Organization. International Classification of Diseases, 9th revision. Geneva: WHO, 2015 All Rights Reserved. C. R. Bard, Inc. does not guarantee that use of any of the codes provided will ensure coverage or payment at any particular level. Medicare may implement policies differently in various sections of the country. Physicians and hospitals should confirm with a particular payor or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular procedure or combination of procedures. Reimbursement for a product or procedure can be different depending upon the setting in which the product is used. Coverage and payment policies also change over time, so that information provided here may at some point need to be revised. NOTES APC Status 5072 Q1 STV-PackagPaid under OPPS; Addendum B displays APC assignments when services are separately payable. (1) Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator S, T, or V. (2) In other circumstances, payment is made through a separate APC payment. 6 of 6