Reimbursement
Reimbursement Guide
Transitional Pass Through (TPT) Payment Reimbursement Information for VasQ Extravascular Support Device for Surgical Arteriovenous Fistula (AVF) Creation
2024 Coding Information for Hospital Outpatient Departments
Effective October 1, 2024, the Centers for Medicare and Medicaid Services (CMS) established HCPCS code C8000 for hospital outpatient departments (HOPDs) to report the VasQ external support device through its Transitional Pass-Through (TPT) Payment Program.
TPT provides incremental reimbursement in addition to the applicable Ambulatory Payment Classifications (APC) payment to recognize the additional cost of technology, like the VasQ device, when paired with appropriate CPT® codes for the creation of an extravascular supported arteriovenous fistula (AVF).
The TPT Payment Program facilitates access for Medicare Fee for Service beneficiaries to the advantages of new and truly innovative devices by allowing for incremental payment while the necessary Hospital Outpatient cost data is collected. Proper reimbursement data helps CMS accumulate adequate claims and cost information to determine an appropriate future APC payment rate for procedures that include the VasQ device.
How to Utilize C8000
In order to be eligible for TPT reimbursement for
the VasQ device, HOPDs must pair C8000 with
Current Procedural Terminology (CPT) codes
36818, 36819, 36820, 36821, 36832, or 36833
when the VasQ device is used in that procedure.
If C8000 is not reported with a correct CPT code,
TPT reimbursement for the VasQ device will not be
granted. dialysis patients.
C8000 should always be paired with one of the following CPT codes:
C8000
Support device, extravascular,
for arteriovenous fistula (implantable)
Calculating Hospital Total Reimbursement for VasQ
CMS determines the incremental TPT payment amounts on a case-by-case basis for each hospital; it is not a set payment amount. The TPT payment amount is typically calculated based on:
- What the hospital charges for VasQ, which includes a hospital’s charge adjustment or markup to account for its operating and capital costs
- The hospital’s cost-to-charge ratio (CCR) for Implantable Medical Devices, typically reported under Medicare’s Revenue Center 278. CMS applies this CCR to the charges a hospital submits to determine the cost of a device to the hospital, and
- The device related portion (device offset) of the relevant HCPCS procedure code. Device offset is a deduction applied to the APC rate for a CPT code that reflects the portion of an existing device cost being replaced by the new device’s cost. CMS established a $0 device offset for C8000 as no existing devices were being replaced and subsequently. Therefore, the device offset does not need to be considered in the reimbursement calculation for VasQ.
Incremental TPT Payment
for VasQ device
CCR to HOPD
from CMS to HOPD
FAQs
The Provider specific CCRs are part of the CMS Outpatient Rate Setting Files. Hospital specific CY24 CCRs are available by contacting your MAC. Please have your Medicare provider number available. If you do not know your Medicare provider number, please contact us via email at VasQ@priahealthcare.com.
The best source of information regarding claims processing issues is the payer, whether a private insurance company or Medicare Administrative Contractor for traditional Medicare Fee-For-Service (FFS) patients.
For additional information, contact Laminate Medical Customer Service at
+1 (866) 969-5633 or send us an email at VasQ@priahealthcare.com.
In 2020, the FDA granted the VasQ device Breakthrough Devices Designation (BDD) based in part on the breadth of clinical evidence collected so far for VasQ showing an improvement over the standard of care. CMS has provided an alternative reimbursement pathway for innovative technologies that have received FDA BDD to qualify for TPT payment, which allows Medicare to support patient access to new technology while continuing to gather data on cost and appropriate clinical APC assignment.
Medicare published that the effective date of the TPT for VasQ is October 1, 2024 and allows TPT payments for a full three-year term. Therefore, VasQ will be eligible for TPT payment for procedures with a date of service prior to and including September 30, 2026.
Medicare Advantage and Private insurance plans can be billed for the additional charges associated with using VasQ with the paired C8000 code. However, TPT payment only applies to Medicare FFS claims that include the C-Code identifying that VasQ was utilized. While commercial and Medicare Advantage plans often use Medicare FFS payment rates as a reference when establishing their own payment rates, the coding and payment policies of commercial payers may vary.
The coding, coverage, and payment information contained herein is for illustrative purposes, has been gathered from various resources, and is subject to change without notice. This document does not constitute legal advice or a recommendation regarding clinical practice. Laminate Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by many variables. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for medically necessary services rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies.
VasQ is intended for use as an external support for upper extremity arteriovenous fistulas created for vascular access by means of vascular surgery. Prior to use, please reference the Instructions for Use for more information on indications, contraindications, warnings, precautions and adverse events available at https://laminatemedical.com/eIFU.