2016 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions

2016 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions This Procedural Payment Guide for interventional cardiology procedures provides coding and reimbursement information for physicians and healthcare facilities. The codes included in this guide are intended to represent typical interventional cardiology procedures where there is: 1) at least one product approved by the U.S. Food and Drug Administration (FDA) for use in the listed procedure; and 2) specific procedural coding guidance provided by a recognized coding or reimbursement authority such as the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS). This guide is in no way intended to promote the off label use of medical devices. Please note that while these materials are intended to provide coding information for a range of interventional cardiology procedures, the FDA approved/cleared labeling for all products may not be consistent with all uses described in these materials. Some payers, including some Medicare contractors, may treat a procedure which is not specifically covered by a product s FDA approved labeling as a non covered service. The Medicare reimbursement amounts shown are currently published national average payments. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non labor costs, hospital teaching status, proportion of low income patients, coverage, and/or payment rules. Please feel free to contact the Boston Scientific reimbursement department at 1 800 CARDIAC if you have any questions about the information in these materials. You can also find reimbursement updates on our website, www.bostonscientific.com/reimbursement Billing and Payment: Medicare and most other insurers typically reimburse physicians based on fee schedules tied to Current Procedural Terminology 1 (CPT ) codes. CPT codes are published by the AMA and used to report medical services and procedures performed by or under the direction of physicians. payment for procedures performed in an outpatient or inpatient hospital or Ambulatory Surgical Center (ASC) setting is described as an in facility fee payment (listed as In in document) while payment for procedures performed in the physician office is described as an in office payment. In facility payments reflect modifier 26 as applicable. Billing and Payment: Medicare reimburses hospitals for outpatient stays (typically stays that do not span 2 midnights) under Ambulatory Payment Classification () groups. Medicare assigns an to a procedure based on the billed CPT/HCPCS (Healthcare Common Procedural Coding System) code. (Note that private insurers may require other procedure codes for outpatient payment.) While it is possible that separate payments may be deemed appropriate where more than one procedure is done during the same outpatient visit, many s are subject to reduced payment when multiple procedures are performed on the same day. Comprehensive s (J1 status indicator) can impact total payment received for outpatient services. Billing and Payment: Medicare reimburses hospital inpatient procedures based on the Medicare Severity Diagnosis Related Group (MS DRG). The MS DRG is a system of classifying patients based on their diagnoses and the procedures performed during their hospital stay. MS DRGs closely calibrate payment to the severity of a patient s illness. One single MS DRG payment is intended to cover all hospital costs associated with treating an individual during his or her hospital stay, with the exception of professional (e.g., physician) charges associated with performing medical procedures. Private payers may also use MS DRG based systems or other payer specific system to pay hospitals for providing inpatient services. : Potential procedure codes are included within this guide. Due to the number of potential codes within the system, the codes included in this document do not fully account for all procedure code options. Some codes outlined in this guide include an " _" symbol. For example, 027_34Z is listed as a potential code for reporting a coronary drug eluting stent procedure. In this example, the "_" character could be 0, 1, 2 or 3, depending on the number of sites treated. The "_" symbol is not a recognized character within the system. ASC Billing and Payment: Many elective procedures are performed outside of the hospital in Medicare certified facilities also known as Ambulatory Surgical Centers (ASCs). Not all procedures that Medicare covers in the hospital setting are eligible for payment in an ASC. Medicare has a list of all services (as defined by CPT/HCPCs codes), generally nonsurgical, that it covers when offered in an ASC. ASC allowed procedures can be found at http://www.cms.hhs.gov/ascpayment/. Payments made to ASCs from private insurers depend on the contract the facility has with the payer. Disclaimer Please note: this coding information may include codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. Health economics and reimbursement information provided by Boston Scientific Corporation is gathered from third party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is provided for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA approved label. coding or site of service requirements. The coding options listed within this guide are commonly relevant manuals for appropriate coding options. 1 CPT Copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Boston Scientific does not promote the use of its products outside their FDA approved label. See Page 9 for Sources and Footnotes See page 1 for important information about the uses and limitations of this document IC 362504 AA Dec 2015 1 of 11

and ASC information effective through December 31, 2016 Diagnostic Cardiac Catheterization Average Payment 3 Medicare Cardiac valve & other major cardiothoracic proc with cardiac catheterization without CC/ MCC Cardiac defibrillator implant with cardiac catheterization with AMI/HF/Shock with MCC 6 Cardiac defibrillator implant with cardiac catheterization with AMI/HF/Shock without MCC 6 Cardiac defibrillator implant with cardiac cath without AMI/HF/Shock with MCC 6 93456 Catheter placement in coronary artery(s) for coronary angiography, including $340 6.15 $44,959 placement intraprocedural injection(s) for coronary angiography, imaging supervision and 9.49 225: 9345626 93457 interpretation; with right heart catheterization Catheter placement in coronary artery(s) for coronary angiography, including $381 6.89 Cardiac defibrillator implant with cardiac catheterization without placement intraproceduralinjection(s) for coronary angiography, imaging supervision and 10.64 AMI/HF/Shock without MCC 6 9345726 interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free $34,579 arterial, venous grafts) including intraprocedural injection(s) for bypass graft 233: angiography and right heart catheterization Coronary bypass with cardiac cath with MCC 93458 Catheter placement in coronary artery(s) for coronary angiography, including $324 5.85 $43,448 placement intraprocedural injection(s) for coronary angiography, imaging supervision and 9.04 234: 9345826 interpretation; with left heart catheterization including intraprocedural injection(s) Coronary bypass with cardiac for left ventriculography, when performed catheterization without MCC 93459 Catheter placement in coronary artery(s) for coronary angiography, including $365 6.60 $28,978 placement intraprocedural injection(s) for coronary angiography, imaging supervision and 10.19 286: interpretation; with left heart catheterization including intraprocedural injection(s) 9345926 for left ventriculogr+b13aphy, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography $12,858 93460 Catheter placement in coronary artery(s) for coronary angiography, including $406 7.35 287: placement intraproceduralinjection(s) for coronary angiography, imaging supervision and 11.34 interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed cardiac catheterization without MCC 9346026 $6,827 93461 Catheter placement in coronary artery(s) for coronary angiography, including $448 8.10 302: placement intraproceduralinjection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft 12.50 Atherosclerosis with MCC $6,253 303: Atherosclerosis without MCC 9346126 angiography $3,795 In Facility 93451 Right heart catheterization including measurement(s) of oxygen saturation and $149 2.72 5188 4A023N6 216: right cardiac output, when performed 4.16 Diagnostic cardiac 4A020N6 93530 Right heart catheterization, for congenital cardiac anomalies $228 4.22 catheterization right 6.37 93452 Left heart catheterization including intraprocedural injection(s) for left $262 4.75 $2,549 4A023N7 $55,884 left ventriculography, imaging supervision and interpretation, when performed 7.30 4A020N7 217: 9345226 93462 Left heart catheterization by transseptal puncture through intact septum or by $217 3.73 left transapical puncture (List separately in addition to code for primary procedure) 6.07 9346226 $36,950 93453 Combined right heart catheterization and left heart catheterization including $345 6.24 4A023N8 218: combined intraprocedural injection(s) for left ventriculography, imaging supervision and 9.64 4A020N8 9345326 93531 interpretation, when performed Combined right heart catheterization and retrograde left heart catheterization, for $446 8.34 combined congenital cardiac anomalies 12.44 $32,367 93532 Combined right heart catheterization and transseptal left heart catheterization $553 9.99 222: combined through intact septum, with or without retrograde left heart catheterization, for 15.44 9353226 93533 congenital cardiac anomalies Combined right heart catheterization and transseptal left heart catheterization $369 6.69 combined through existing septal opening, with or without retrograde left heart 10.31 $50,301 9353326 catheterization, for congenital cardiac anomalies) 223: 93454 Catheter placement in coronary artery(s) for coronary angiography, including $265 4.79 B21 ZZ placement intraprocedural injection(s) for coronary angiography, imaging S&I 7.40 9345426 93455 Catheter placement in coronary artery(s) for coronary angiography, including $306 5.54 $37,806 placement intraprocedural injection(s) for coronary angiography, imaging supervision and 8.55 224: 9345526 interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including intraprocedural injection(s) for bypass graft angiography Total Cardiac valve & other major cardiothoracic procedures with cardiac catheterization with MCC Cardiac valve & other major cardiothoracic procedures with cardiac catheterization with CC cardiac catheterization with MCC IC 362504 AA Dec 2015 2 of 11

and ASC information effective through December 31, 2016 Average Payment 3 Medicare Injection Diagnostic Cardiac Catheterization Each site may be injected multiple times, only report each code once +93563 Injection procedure during cardiac catheterization including imaging supervision, $61 1.11 Status N, items and 3E053KZ NA 7 93563 interpretation, and report; for selective coronary angiography during congenital 1.69 services packaged 3E063KZ heart catheterization (List separately in addition to code for primary procedure) into primary procedure rate. +93564 Injection procedure during cardiac catheterization including imaging supervision and $64 1.13 No separate payment 3E053KZ 93564 interpretation, and report; for selective opacification of aortocoronary venous or 1.78 3E063KZ arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) +93565 Injection procedure during cardiac catheterization including imaging supervision and $48 0.86 3E073KZ interpretation, and report; for selective left ventricular or left arterial angiography 1.33 3E083KZ 93565 +93566 (List separately in addition to code for primary procedure) Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective right ventricular or right atrial angiography $48 0.86 1.34 (List separately in addition to code for primary procedure) 93566 +93567 Injection procedure during cardiac catheterization including imaging supervision and $54 0.97 3E053KZ interpretation, and report; for supravalvular aortography (List separately in addition 1.52 3E063KZ to code for primary procedure) 93567 +93568 Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for pulmonary angiography (List separately in addition to $49 0.88 1.37 code for primary procedure) 93568 Miscellaneous +93463 Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of $101 2.00 Status N, items and 3E073KZ NA 7 nitroprusside, dobutamine, milrinone, or other agent) including assessing 2.81 services packaged 3E083KZ hemodynamic measurements before, during, after and repeat pharmacologic agent into primary 93463 administration, when performed (List separately in addition to code for primary procedure rate. procedure) No separate payment +93464 Physiologic exercise study (eg, bicycle or arm ergometry) including assessing $89 1.80 4A1335C 93464 hemodynamic measurements before and after (List separately in addition to code for 2.48 primary procedure) 9346426 Coronary Angioplasty (PTCA), without stent (See page 10 for Complexity Adjustment Code Combinations) Billed in conjunction with Procedure Code. Use physician modifier 26 as appropriate 92920 Percutaneous transluminal coronary angioplasty; single major coronary $569 10.10 5191 027_3ZZ 250: artery or branch 15.87 Level I Endovascular 027_3Z6 Percutaneous cardiovascular procedures without coronary artery stent with MCC $4,592 $15,928 +92921 Percutaneous transluminal coronary angioplasty; each additional branch of $0 0.00 NA 251: 92921 a major coronary artery (list separately in addition to code for primary 0.00 Complexity Percutaneous cardiovascular procedure) adjustment may procedures without coronary artery apply stent without MCC Coronary Atherectomy, without stent (See page 10 for Complexity Adjustment Code Combinations) 92924 Percutaneous transluminal coronary atherectomy, with coronary $675 11.99 5192 02C_3ZZ 250: angioplasty when performed; single major coronary artery or branch 18.84 Level II Endovascular Percutaneous cardiovascular procedures without coronary artery stent with MCC $9,542 $15,928 +92925 Percutaneous transluminal coronary atherectomy, with coronary $0 0.00 NA 251: angioplasty when performed; each additional branch of a major coronary 0.00 Percutaneous cardiovascular procedures artery (list separately in addition to code for primary procedure) without coronary artery stent without 92925 MCC $9,957 $9,957 IC 362504 AA Dec 2015 3 of 11

and ASC information effective through December 31, 2016 Average Payment 3 Medicare Non Drug Eluting Stent with Angioplasty (PTCA) (See page 10 for Complexity Adjustment Code Combinations) 92928 Percutaneous transcatheter placement of intracoronary stent(s), with $631 11.21 5192 027_3DZ 248: coronary angioplasty when performed; single major coronary artery or 17.62 Level II Endovascular 027_3D6 branch $9,542 $18,125 249: +92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary $0 0.00 NA Percutaneous cardiovascular proc w 92929 angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) 0.00 non drug eluting stent without MCC Drug Eluting Stent with Angioplasty (PTCA) (See page 10 for Complexity Adjustment Code Combinations) C9600 Percutaneous transcatheter placement of drug eluting intracoronary NA 5192 027_34Z 246: stent(s), with coronary angioplasty when performed; single major Level II Endovascular 027_346 coronary artery or branch C9602 Percutaneous transluminal coronary atherectomy, with drug eluting NA 5193 027_34Z 246: intracoronary stent, with coronary angioplasty when performed; single Level III Endovascular 027_346 major coronary artery or branch 02C_3ZZ Non Drug Eluting Stent Coronary Revascularization Bypass Graft s use codes 92928/+92929 $9,542 $19,187 +C9601 Percutaneous transcatheter placement of drug eluting intracoronary NA 247: stent(s), with coronary angioplasty when performed; each additional branch of major coronary artery Complexity adjustment may apply Percutaneous cardiovascular proc w drug eluting stent without MCC Non Drug Eluting Stent with Atherectomy 92933 Percutaneous transluminal coronary atherectomy, with intracoronary $706 12.54 5193 027_3DZ 248: stent, with coronary angioplasty when performed; single major coronary artery or branch 19.71 Level III Endovascular 027_3D6 02C_3ZZ Percutaneous cardiovascular proc w $14,612 $18,125 +92934 Percutaneous transluminal coronary atherectomy, with intracoronary $0 0.00 NA 249: 92934 stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary #N/A Percutaneous cardiovascular proc w non drug eluting stent without MCC procedure Drug Eluting Coronary Stent with Atherectomy s use codes 92928/+92929 $14,612 $19,187 +C9603 Percutaneous transluminal coronary atherectomy, with drug eluting NA 247: intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery drug eluting stent without MCC 92937 Percutaneous transluminal revascularization of or through coronary artery bypass $631 11.20 5192 027_3DZ 248: graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; 17.60 Level II Endovascular 027_3D6 02C_3ZZ single vessel $9,542 $18,125 +92938 Percutaneous transluminal revascularization of or through coronary artery $0 0.00 NA 249: 92938 bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection 0.00 non drug eluting stent without MCC when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure) IC 362504 AA Dec 2015 4 of 11

and ASC information effective through December 31, 2016 Average Payment 3 Medicare Non Drug Eluting Stent Coronary Revascularization (continued) Acute Myocardial Infarction 92941 Percutaneous transluminal revascularization of acute total/subtotal $708 12.56 5192 027_3DZ 248: 19.75 Level II Endovascular 027_3D6 02C_3ZZ occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel $9,542 $18,125 Chronic Total Occlusion 249: 92943 Percutaneous transluminal revascularization of chronic total occlusion, $707 12.56 5192 027_3DZ coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; 19.74 Level II Endovascular 027_3D6 02C_3ZZ single vessel $9,542 +92944 Percutaneous transluminal revascularization of chronic total occlusion, $0 0.00 NA 92944 coronary artery, coronary artery branch, or coronary artery bypass graft, 0.00 any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure) Drug Eluting Stent Coronary Revascularization Bypass Graft (See page 10 for Complexity Adjustment Code Combinations) C9604 Percutaneous transluminal revascularization of or through coronary artery NA 5192 027_34Z 246: Level II Endovascular 027_346 02C_3ZZ bypass graft (internal mammary, free arterial, venous), any combination of s use drug eluting intracoronary stent, atherectomy and angioplasty, including codes distal protection when performed; single vessel 92928/+92929 $9,542 $19,187 +C9605 Percutaneous transluminal revascularization of or through coronary artery NA 247: bypass graft (internal mammary, free arterial, venous), any combination of drugeluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft Acute Myocardial Infarction C9606 Percutaneous transluminal revascularization of acute total/subtotal NA 5193 Level III Endovascular 027_34Z 027_346 02C_3ZZ occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel Drug Eluting Stent Coronary Revascularization (continued) Chronic Total Occlusion Percutaneous transluminal revascularization of chronic total occlusion, BSC currently has no stents FDA approved for CTOs s use codes 92928/+92929 $14,612 drug eluting stent without MCC C9607 NA 5193 027_34Z 246: Level III Endovascular 02C_3ZZ coronary artery, coronary artery branch, or coronary artery bypass graft, s use any combination of drug eluting intracoronary stent, atherectomy and codes angioplasty; single vessel 92928/+92929 $14,612 $19,187 +C9608 Percutaneous transluminal revascularization of chronic total occlusion, NA 027_346 247: 027_34Z coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft Complexity adjustment may apply non drug eluting stent without MCC drug eluting stent without MCC IC 362504 AA Dec 2015 5 of 11

and ASC information effective through December 31, 2016 Average Medicare Payment 3 Intravascular Ultrasound (Use physician modifier 26 as appropriate) +92978 Intravascular ultrasound (coronary vessel or graft) during diagnostic $99 1.80 Status N, items and B240ZZ3 231: 92978 evaluation and/or therapeutic intervention including imaging supervision, 2.77 services packaged B241ZZ3 Coronary bypass with PTCA with MCC 9297826 interpretation and report; initial vessel (List separately in addition to code into primary for primary procedure) procedure rate. $46,090 No separate payment 232: Coronary bypass with PTCA without MCC +92979 Intravascular ultrasound (coronary vessel or graft) during diagnostic $80 1.44 92979 evaluation and/or therapeutic intervention including imaging supervision, 2.22 $34,117 9297926 246: interpretation and report; each additional vessel (List separately in addition to code for primary procedure) Fractional Flow Reserve (FFR) $19,187 +93571 Intravascular Doppler velocity and/or pressure derived coronary flow $99 1.80 Status N, items and 4A033BC 247: 93571 reserve measurement (coronary vessel or graft) during coronary 2.77 services packaged 9357126 angiography including pharmacologically induced stress; initial vessel (List into primary procedure rate. separately in addition to code for primary procedure) No separate payment +93572 Intravascular Doppler velocity and/or pressure derived coronary flow $80 1.44 93572 reserve measurement (coronary vessel or graft) during coronary 2.22 9357226 angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) 248: $18,125 249: non drug eluting stent without MCC 250: $15,928 251: Percutaneous cardiovascular procedures without coronary artery stent without MCC $9,957 286: cardiac catheterization with MCC Intravascular Ultrasound (Peripheral Interventions) Use physician modifier 26 as appropriate 37252 Intravascular ultrasound (non coronary vessel) during diagnostic $97 1.80 Status N, items and B44_ZZ3 252: evaluation and/or therapeutic intervention; initial vessel (List separately in 2.70 services packaged B54_ZZ3 addition to code for primary procedure) into rate. No separate payment. drug eluting stent without MCC Percutaneous cardiovascular procedures without coronary artery stent with MCC $12,858 287: cardiac catherization without MCC $6,827 Other vascular procedures w/mcc $19,410 253: Other vascular procedures w/cc 37253 Intravascular ultrasound (non coronary vessel) during diagnostic $77 1.44 $15,369 evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure) 2.16 254: Other vascular procedures without CC/MCC $10,175 IC 362504 AA Dec 2015 6 of 11

and ASC information effective through December 31, 2016 Average Payment 3 Medicare Thrombectomy +92973 Percutaneous transluminal coronary thrombectomy mechanical (List $185 3.28 NA 02C_3ZZ 246: 92973 separately in addition to code for primary procedure) 5.15 Percutaneous Balloon Valvuloplasty; Aortic Valve $19,187 247: drug eluting stent without MCC 248: $18,125 249: non drug eluting stent without MCC 250: Percutaneous cardiovascular procedures without coronary artery stent with MCC $15,928 251: Percutaneous cardiovascular procedures without coronary artery stent without MCC $9,957 286: cardiac catheterization with MCC $12,858 287: cardiac catherization without MCC 92986 Percutaneous balloon valvuloplasty; aortic valve $1,387 22.85 5191 027F3ZZ 273: 38.72 Level I Endovascular 027F4ZZ Percutaneous intracardiac procedures with MCC $20,961 $4,539 274: 92987 Percutaneous balloon valvuloplasty; mitral valve $1,430 23.63 5192 027G3ZZ Percutaneous intracardiac procedures 39.92 Level II Endovascular 027G4ZZ without MCC $14,288 $9,542 92990 Percutaneous balloon valvuloplasty; pulmonary valve $1,129 18.27 027H3ZZ 31.51 027H4ZZ $6,827 IC 362504 AA Dec 2015 7 of 11

and ASC information effective through December 31, 2016 Endovascular or Transthoracic Valves In Facility Total Average Payment 3 Medicare 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,421 25.13 NA 02RF37Z 266: Aortic percutaneous femoral artery approach 39.65 Only 02RF38Z 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,553 27.52 Procedure 02RF3JZ Aortic open femoral artery approach 43.36 02RF3KZ $50,772 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,614 28.50 267: Aortic open axillary artery approach 45.04 33364 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,692 30.00 Aortic open iliac artery approach 47.22 $38,720 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,862 33.12 Aortic transaortic approach (e.g., median sternotomy, mediastinotomy) 51.98 33366 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $2,015 35.88 02RF3JH Aortic transapical exposure (eg, left thoracotomy) 56.24 +33367 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $655 11.88 02RF3_Z Aortic cardiopulmonary bypass support with percutaneous peripheral arterial 18.27 5A1221Z 33367 and venous cannulation (e.g., femoral vessels) (list separately in addition to code for primary procedure) Endovascular cardiac valve replacement with MCC Endovascular cardiac valve replacement without MCC +33368 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $785 14.39 02RF0_Z Aortic cardiopulmonary bypass support with open peripheral arterial and venous 21.91 5A1221Z 33368 cannulation (e.g., femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure) +33369 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; $1,037 19.00 02RF3JZ Aortic cardiopulmonary bypass support with central arterial and venous 28.95 5A1221Z 33369 cannulation (e.g., aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure) 0262T Implantation of catheter delivered prosthetic pulmonary valve, Carrier 0.00 02RH3_Z Pulmonary endovascular approach priced 33999 Unlisted procedure, cardiac surgery 02RH3_H 33418 Transcatheter mitral valve repair, percutaneous approach, including $1,874 32.25 02UG3JZ 273: transseptal puncture when performed; initial prosthesis 52.30 Percutaneous intracardiac procedures +33419 Transcatheter mitral valve repair, percutaneous approach, including $441 7.93 with MCC $20,961 transseptal puncture when performed; additional prosthesis(es) during 12.31 274: 33419 same session (List separately in addition to code for primary procedure) Percutaneous intracardiac procedures without MCC $14,288 IC 362504 AA Dec 2015 8 of 11

and ASC information effective through December 31, 2016 Average Payment 3 Medicare WATCHMAN TM Left Atrial Appendage Closure (LAAC) Procedure 0281T 0.00 02L73DK 273: Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s) left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation Carrier Priced WATCHMAN is a registered or unregistered trademark of Boston Scientific Corporation NA Only Procedure Percutaneous intracardiac procedures with MCC $20,961 274: Percutaneous intracardiac procedures without MCC $14,288 1. Current Procedural Terminology (CPT) 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. 2. Source: CMS website. Fee Schedule 2016 National Fee Schedule Relative Value File: https://www.cms.gov/medicare/medicare Fee for Service Payment/FeeSched/PFS Relative Value Files.html 3. Source: CMS website. 2016 OPPS Addendum B: https://www.cms.gov/medicare/medicare Fee for Service Payment/PPS/ Regulationsand Notices.html 4. Source: CMS ICD 10 CM/PCS MS DRG v33 Definitions Manual https://www.cms.gov/icd10manual/version33 fullcode cms/fullcode_cms/p0001.html 5. Source: Data tables (FY2016 IPPS Final Rule). CMS Website. National average (wage index greater than one) MS DRG rates calculated using the national adjusted full update standardized labor, non labor and capital amounts. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non labor costs, hospital teaching status, and/or proportion of low income patients). https://www.cms.gov/medicare/medicare Fee for Service Payment/AcutePPS/FY2016 IPPS Final Rule Home Page.html 6. Not intended as an all inclusive list of MS DRGs. 7. MS DRG grouping is driven by other primary procedures that are performed in conjunction with this procedure. 8. Total RVU is the relative value unit total for In Facility calculation 0 0 $0 0 0 0 0 IC 362504 AA Dec 2015 9 of 11

Description 2016Complexity Adjustment Interventional Cardiology Code Combinations for Comprehensive s (c s) 5191, 5192 and 5193 CY 2016 Final Payment 5191 Level I Endovascular $4,592 5192 Level II Endovascular $9,542 5193 Level III Endovascular $14,612 Interventional Cardiology PCI Complexity Adjustment CPT Combinations (5191 base code plus second CPT equals 5192 payment) Primary HCPCS Code Primary Short Descriptor Primary SI Primary Code Base Secondary or Device Add on HCPCS Code Secondary Short Descriptor Secondary SI Secondary Code Base Complexity Adjusted 92920 Prq cardiac angioplast 1 art J1 5191 92920 Prq cardiac angioplast 1 art J1 5191 5192 92920 Prq cardiac angioplast 1 art J1 5191 92974 Cath place cardio brachytx N 5192 Complexity Adjustment CPT Combinations (5192 base code plus second CPT equals 5193 payment) Primary HCPCS Code Interventional Cardiology PCI Base s and Payment Primary Short Descriptor Primary SI Primary Code Base Secondary or Device Add on HCPCS Code Secondary Short Descriptor Secondary SI Secondary Code Base Complexity Adjusted 92924 Prq card angio/athrect 1 art J1 5192 C9600 Perc drug el cor stent sing J1 5192 5193 92928 Prq card stent w/angio 1 vsl J1 5192 37221 Iliac revasc w/stent J1 5192 5193 92928 Prq card stent w/angio 1 vsl J1 5192 C9601 Perc drug el cor stent bran N 5193 C9600 Perc drug el cor stent sing J1 5192 33208 Insrt heart pm atrial & vent J1 5223 5193 C9600 Perc drug el cor stent sing J1 5192 33210 Insert electrd/pm cath sngl J1 5222 5193 C9600 Perc drug el cor stent sing J1 5192 33282 Implant pat active ht record J1 5222 5193 C9600 Perc drug el cor stent sing J1 5192 37221 Iliac revasc w/stent J1 5192 5193 C9600 Perc drug el cor stent sing J1 5192 37236 Open/perq place stent 1st J1 5192 5193 C9600 Perc drug el cor stent sing J1 5192 92937 Prq revasc byo graft 1 vsl J1 5192 5193 C9600 Perc drug el cor stent sing J1 5192 C9600 Perc drug el cor stent sing J1 5192 5193 C9600 Perc drug el cor stent sing J1 5192 C9601 Perc drug el cor stent bran N 5193 C9604 Perc d e cor revasc t cabg s J1 5192 C9600 Perc drug el cor stent sing J1 5192 5193 C9604 Perc d e cor revasc t cabg s J1 5192 C9604 Perc d e cor revasc t cabg s J1 0229 5193 C9604 Perc d e cor revasc t cabg s J1 5192 C9605 Perc d e cor revasc tcabg b N 5193 5193 is Highest Level in the Vascular family, payment is capped at the 5193 level Complexity Adjustment Combinations (CMS Defined Combination based on Cost) are Two CPT combinations identified that high cost results in next highest vascular family payment when billed together Note: 1. All complexity adjustment stay in the same "Comprehensive" family 2. IC and PI s 5191, 5192 and 5193 are in the same Comprehensive family defined as Vascular (VASCX) 3. 2016 payment adjustments are two CPT code combinations (complexity adjustments) pre defined by CMS based on cost 4. The highest payment, even with Complexity Adjustments is 5193 5. Base codes in 5193 are at the highest vascular family c payment level, no additional complexity adjustments apply. 1 CPT copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. 2 Source: CMS Medicare Fee for Service Payment_ PPS CY2016 OPPS Addendums J found at https://www.cms.gov/medicare/medicare Fee for Service Payment/PPS/ Regulations and Notices Items/CMS 1633 FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending IC 362504 AA Dec 2015 10 of 11

Category C Code Reference Guide 2016 Interventional Cardiology Quarterly updates can be found on the Medicare website (http://www.cms.hhs.gov/pps/). Background: C Codes are used for hospital outpatient device reporting for Medicare and some private payers. A limited number of C Codes are eligible for additional pass through payment from Medicare for the associated device. Device dependent s may be denied without applicable C Codes. C Codes are VERY important to future reimbursement. Use of all applicable C Codes on a claim allows identification of device(s) utilized in a procedure and may affect future payment rates. CORONARY Category C Code C1724 C1725 C1753 C1757 C1769 C1874 C1876 C1884 C1887 C1894 Category C Code Description Catheter, transluminal atherectomy, rotational Catheter, transluminal angioplasty, non laser (may include guidance, infusion/perfusion capability) Catheter, intravascular ultrasound Catheter, Embolectomy/thrombectomy Guide Wire Stent, coated/covered, with delivery system Stent, noncoated/noncovered, with delivery system Embolization protective system Catheter, guiding (may include infusion/perfusion capability) Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser Disclaimer Please note: This coding information may include some codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. Health economics and reimbursement information provided by Boston Scientific Corporation is gathered from third party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is provided for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDAapproved label. coding or site of service requirements. The coding options listed within this guide are commonly relevant manuals for appropriate coding options. coding or site of service requirements. The coding options listed within this guide are commonly relevant manuals for appropriate coding options. CPT Disclaimer CPT copyright 2015. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. We welcome your feedback. Please send comments to lorenzd@bsci.com 1 CPT copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. IC 362504 AA Dec 2015 11 of 11