Centers for Medicare and Medicaid Services Establishes New Category I CPT Add-On Code for Coronary IVL

November 7, 2023 — Shockwave Medical, Inc, a pioneer in the development and commercialization of transformational technologies for the treatment of cardiovascular disease, announced today that as part of the Calendar Year 2024 Physician Fee Schedule (PFS) final rule, the U.S. Centers for Medicare & Medicaid Services (CMS) has established a Category I Current Procedural Terminology (CPT) add-on code for procedures involving coronary Intravascular Lithotripsy (IVL). These updates will become effective January 1, 2024. 

The new CPT code, +92972, has been created to describe when coronary IVL is performed and has been assigned work Relative Value Units (RVU) and professional fees that remunerate physicians for the additional work associated with performing coronary IVL. Because +92972 is an add-on code, the work RVUs and fees associated with coronary IVL will be added to the remuneration physicians receive for percutaneous coronary intervention (PCI) procedures, including when atherectomy is also performed. The relevant code is as follows: 

CMS-1784-F; Medicare Physician Fee Schedule Fiscal Year 2024 Final Rule 

Payment rates do not take into account geographical or additional adjustments. Providers should contact their local Medicare Administrative Contractor (MAC) or CMS for specific information as payment rates vary by region. 

Prior to the establishment of CPT code +92972, there were no additional RVUs or fees for physicians who performed coronary IVL. CMS first proposed the new CPT add-on code via the FY2024 Proposed PFS which, following a 60-day public comment period, has now been finalized. 

"We would like to thank the cardiology medical societies, the American Medical Association CPT Editorial Panel and staff and CMS for their work in establishing a new CPT code for coronary IVL. Now that additional work RVUs and professional fees are associated with coronary IVL, we believe physicians will be appropriately remunerated for their commitment to adequate lesion preparation in these complex interventions involving calcified coronary arteries," said Robert Fletcher, Senior Vice President of Marketing and Market Access at Shockwave Medical. 

CPT is a registered trademark of the American Medical Association. The coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. Shockwave Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies. 

For more information: www.shockwavemedical.com