HCPCS DEVICE CATEGORY C-CODES

1 1 This guide provides physician and hospital coding and reimbursement information. In addition, Abbott offers a reimbursement hotline, which provides live coding and billing information from dedicated reimbursement specialists. Hotline support is available from 8 to 5 Central Time, Monday through Friday at (855) 569-6430 or Hotline reimbursement assistance is provided subject to the disclaimers set forth in this document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement , coding, business or other advice.

2 Furthermore, it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by Abbott regarding levels of reimbursement , payment or charge, or that reimbursement or other payment will be received. Similarly, nothing in this document should be viewed as instructions for selecting any particular code. The ultimate responsibility for coding and obtaining payment/ reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. Also note that the information presented herein represents only one of many potential scenarios, based on the assumptions, variables and data presented.

3 In addition, the customer should note that laws, regulations, coverage and coding policies are complex and updated frequently. Therefore, the customer should check with their local carriers or intermediaries often and should consult with legal counsel or a financial, coding or reimbursement specialist for any coding, reimbursement or billing questions or related issues. This information is for reference purposes only. It is not provided or authorized for marketing Medicare Hospital Outpatient Prospective Payment System (OPPS) requires providers to report DEVICE CATEGORY C-CODES on claims in order to improve the claims data used to annually update the OPPS payment rates.

4 Logic edits have been created to require certain procedures and devices to be billed together. Procedure-to- DEVICE edits may look at billed procedure codes and return claims if certain required DEVICE codes are not billed on the same claim. Likewise, DEVICE -to-procedure edits may look at certain DEVICE codes billed on a claim and may return the claim if a required procedure where the DEVICE was used is not also billed on the same claim. These edits can be found at: #TopOf Page. Revenue Codes and HCPCS CodesLevel II HCPCS codes, including C codes, are not applicable to Valve and Vascular products utilized for in-patient procedures such as valve replacement.

5 C codes are used in conjunction with the Medicare prospective payment system for outpatient procedures codes help hospitals categorize services provided by revenue center. Medicare utilizes revenue codes for cost reporting purposes. For Medicare, revenue codes must be included for each service on a CMS 1450 (UB-04) claim form. It may be appropriate for hospitals to capture the cost of products used for the procedures described above within Revenue Code 0278 (Medical/Surgical Supply Other Implant) or Revenue Code 0360 (Operating Room Services - General). Health Care Common Procedural Coding System ( HCPCS ) codes include level I codes (CPT Code, described above) and level II codes (other products, supplies, and services not included in CPT Code).

6 LVAD REPLACEMENT ACCESSORIES AND SUPPLIES HCPCS CROSSWALKHCPCSCMS DESCRIPTIONCAT #HEARTM ATE II LVAD PRODUCTSQ0478 Power adapter for use with electric or electric/pneumatic ventricular assist DEVICE , vehicle type2230 Power Module DC Input Cable (car charger)Q0479 Power module for use with electric/pneumatic ventricular assist DEVICE , replacement only1340 Power Module107754 Mobile Power Unit HEART FAILUREPULMONARY ARTERY (PA) PRESSURE SENSOR IMPLANTSC- CODEDEVICEMODELC2624 CardioMEMS * SensorCM2000C9741 CardioMEMS GuidewireCM2010* For additional information on the CardioMEMS HF System, please refer to the CardioMEMS HF System reimbursement guide available at ABBOTT THERAPY CODING guide HCPCS DEVICE CATEGORY C-CODES 22017 ABBOTT THERAPY CODING guide | HCPCS DEVICE CATEGORY C-CODES Q0481 Microprocessor control unit for use with electric ventricular assist DEVICE .

7 Replacement only106762 HeartMate II LVAD Pocket Controller103696 HeartMate II LVAD System ControllerQ0483 Monitor/display module for use with electric ventricular assist DEVICE , replacement only1280 NDisplay ModuleQ0485 Monitor control cable for use with electric/pneumatic ventricular assist DEVICE , replacement only103871 Display Module to Power Module CableQ0495 Battery/power pack charger for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only1440 Universal Battery ChargerQ0496 Battery for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only (excludes Li-Ion)109200 Power Module Backup Power (bill each when performing Planned Maintenance on the Power ModuleQ0497 Battery clips for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only286514-Volt Battery Clips Set (bill each))

8 Q0498 Holster for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only104229 Holster Vest, 14-Volt Li-Ion, small104230 Holster Vest, 14-Volt Li-Ion, medium104231 Holster Vest, 14- Volt Li-Ion, large104217 GoGear Holster Vest, 12-Volt SLA, small104218 GoGear Holster Vest, 12-Volt SLA, medium104219 GoGear Holster Vest, 12-Volt SLA, large104224 GoGear Holster Vest, 14-Volt Li-Ion, small104225 GoGear Holster Vest, 14-Volt Li-Ion, medium104226 GoGear Holster Vest, 14-Volt Li-Ion, largeQ0499 Belt/vest/ bag for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only104220 GoGear Modular Belt, 12-Volt SLA, small/medium104221 GoGear Modular Belt, 12-Volt SLA, large104227 GoGear Modular Belt, 14-Volt Li-Ion, small/medium104228 GoGear Modular Belt, 14-Volt Li-Ion, largeQ0499 Belt/vest/ bag for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only106449 Consolidated Bag, Left (for use with the Pocket Controller)104233 Consolidated Bag, Right (for use with the Pocket Controller)

9 104222 Consolidation Bag, blackQ0501 Shower cover for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only104232 Shower Bag104216 GoGear Shower KitQ0506 Lithium Ion battery for use with electric or electric/pneumatic ventricular assist DEVICE , replacement only246514-Volt Li-Ion HeartMate LVAD Battery (bill each)Q0508 Miscellaneous supply or accessory for use with any implanted ventricular assist DEVICE for which payment was not made under Medicare Part A103426 Power Module Patient Cable103860 Power Module/AC CordQ0508 Miscellaneous supply or accessory for use with any implanted ventricular assist DEVICE for which payment was not made under Medicare Part ADriveline Stabilization System1264 System Controller Battery Module100759 Stabilization Belt, small100760 Stabilization Belt.

10 Medium/largeQ0508 Miscellaneous supply or accessory for use with any implanted ventricular assist DEVICE for which payment was not made under Medicare Part A1260 Travel Case (Non-covered by Medicare. Commercial payers may reimburse)106129 Wearable accessory kitHEART FAILURELVAD REPLACEMENT ACCESSORIES AND SUPPLIES HCPCS CROSSWALKHCPCSCMS DESCRIPTIONCAT #HEARTM ATE II LVAD PRODUCTS 32017 ABBOTT THERAPY CODING guide | HCPCS DEVICE CATEGORY C-CODES CARDIAC RHYTHM MANAGEMENT DEVICES C- CODEDEVICEMODELADAPTER/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)C1883 Pacemaker Adapters501203, 501204, 501205, 501206, 501214, 2 XBIS/BIS-17, BVS/VS-15, BLV/BIS-10, BLV/BIS-4403 CARDIOVERTER-DEFIBRILLATOR, DUAL-CHAMBER (IMPLANTABLE)