# drug coated balloon



## schmsuz (Feb 26, 2015)

Can anyone tell me if the billing is different when the physician is using a drug coated balloon as opposed to pta w/o the DCB?  Thanks for your help!


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## Chlrtrep (Feb 26, 2015)

The coding and reimbursement is the same as a non-DEB angioplasty.  This will change effective April 1, 2015 - when a transitional pass-through payment (TPT) will go into effect for DCB.  This will require use of a new c-code (C2623, listed on the file).  The actual outpatient TPT amount is still to be determined - we are awaiting the full transmittal publication to see precisely how CMS will be calculating this.  It is not a designated amount; rather, it is a case-by-case basis and specific to each hospital's cost-to-charge ratio, etc.


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## schmsuz (Feb 26, 2015)

Thanks for the info!  Will there be different coding for the physician professional services?


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## Julie Allred (Aug 14, 2015)

Should the physician bill differently for using a drug coated balloon or does he use the regular angioplasty codes?  Also, should he expect additional reimbursement?


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## Chlrtrep (Aug 14, 2015)

http://www.medtronic.com/wcm/groups...nts/documents/drug-coated-balloon-tpt-faq.pdf

4. Physician professional payments are not impacted when using DCB. The physician will continue to use the same CPT code to describe the work of performing a peripheral angioplasty with a DCB or other balloon angioplasty catheter



The additional payment is for facilities. As the DCB is significantly more expensive then a regular PTA balloon.


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## Julie Allred (Aug 14, 2015)

Thanks so much!  That is exactly what I needed to show my cardiologists.  He was determined that he would be reimbursed more.


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