2021 BILLING AND CODING GUIDE Electromagnetic …

1 2022 BILLING and CODING Guidelines Electromagnetic Navigation bronchoscopy (ENB) 1 | Electromagnetic Navigation bronchoscopy (ENB) procedures with the ILLUMISITETM Platform and the superDimensionTM navigation system provide a minimally invasive approach to accessing difficult-to-reach areas of the lung. CODING included in this GUIDE are examples of procedures that may be completed with these systems. Rates listed in this GUIDE are based on their respective site of care- physician office, ambulatory surgical center, or hospital outpatient department. All rates provided are for the unadjusted Medicare National Average, rounded to the nearest whole number for the 2022 CY, and do not represent adjustments specific to the provider's location or facility.

2 Commercial rates are based on individual contracts. Providers are encouraged to review their commercial payer contracts to verify their specific contracted allowables. All components of the ENB procedure are captured in the reporting of the associated CPT 1 code. Unless otherwise stated in this document, there are no designated HCPCS2 Level II codes assigned for ENB procedures. Providers may choose to perform multiple procedures during the same encounter. When this occurs, the payment may be subject to packaging rules, multiple procedure reduction, or a complexity adjustment. CPT Code1 Description Physician3 Ambulatory Surgical Center4 Hospital Outpatient4 bronchoscopy 31623 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with brushing or protected brushings $134 $658 $1,528 31624 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with bronchial alveolar lavage $135 $658 $1,528 31625 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed.

3 With bronchial or endobronchial biopsy(s), single or multiple sites $158 $658 $1,528 31628 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with transbronchial lung biopsy(s), single lobe $178 $1,329 $3,164 31629 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with transbronchial needle aspiration biopsy(s) trachea, main stern and/or lobar bronchus $188 $1,329 $3,164 Placement of Fiducial or Dye Markers 31626 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with placement of fiducial markers, single or multiple $199 $2,039 $5,947 Electromagnetic Navigation bronchoscopy (ENB) +316275 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) $98 N/A N/A 2 | CPT Code1/ HCPCS Code2 Description Physician3 Ambulatory Surgical Center4 Hospital Outpatient4 Multiple Lobes +31632 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed.

4 With transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure) $50 N/A N/A +31633 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure) $64 N/A N/A CoreCathTM 31641 bronchoscopy , rigid or flexible, including fluoroscopic guidance , when performed; with destruction of tumor or relief of stenosis by any method other than excision ( , laser therapy, cryotherapy) $259 $1,329 $3,164 Endobronchial Ultrasound (EBUS) 31652 bronchoscopy with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures $224 $1,329 $3,164 31653 bronchoscopy with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies])

5 , three or more mediastinal and/or hilar lymph node stations or structures $248 $1,329 $3,164 +31654 bronchoscopy with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s). (List separately in addition to code for primary procedure[s]) $67 N/A N/A Transthoracic Needle Aspiration (TTNA) 32408 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance , when performed $154 $608 $1,437 Supply Codes A4648 Tissue marker, implantable, any type, each Not separately payable, packaged into payment for other procedures For more information, contact the Medtronic MITG Reimbursement Hotline: 877-278-7482 or via email at: 3 | 1.

6 CPT copyright 2021 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. 2. Centers for Medicare & Medicaid Services. Alpha-numeric HCPCS. 3. Centers for Medicare and Medicaid Services.

7 Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Federal Register (86 Fed. Reg. No. 221 64996-66031) Published November 19, 2021. Physician Fee Schedule January 2022 Release. 4. Centers for Medicare and Medicaid Services. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Final Rule, Federal Register (86 Fed. Reg. 63458-63477), Published November 16, 2021. ASC Payment Rates Addenda January 2022 ASC Approved HCPCS Code and Payment Rates-Updated January 4, 2022. 5. CPT code 31627 includes 3D reconstruction.

8 Do not report 31627 in conjunction with 76376 and 76377. Use 31627 in conjunction with 31615, 31622-31626, 31628-31631, 31635, 31636, 31638-31643. CPT code 31627 is an add-on code. Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of BILLING or the amount that will be paid to providers of service.

9 Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of CODING , coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling ( , instructions for use, operator's manual or package insert), consult with your BILLING advisors or payers on handling such BILLING issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

10 2022 Medtronic. All rights reserved. Medtronic, Medtronic logo and Engineering the extraordinary are trademarks of Medtronic. * Third-party brands are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. 01/2022 -US-RE-2000329