Shockwave C2 Coronary Intravascular Lithotripsy (IVL) catheter (estimated average reasonable cost is $5,640) – HCPCS code C1761 (Catheter, transluminal intravascular lithotripsy, coronary

Shockwave C2 Coronary Intravascular Lithotripsy (IVL) catheter (estimated

average reasonable cost is $5,640) – HCPCS code C1761 (Catheter, transluminal

intravascular lithotripsy, coronary)

CMS is finalizing their proposal to continue in 2022 device pass-through payment status for the Coronary IVL Catheter under the alternative pathway for devices that have an FDA Breakthrough Device designation and have FDA marketing authorization. The Coronary IVL catheter is a proprietary lithotripsy device delivered through the coronary arterial system of the heart to the site of an otherwise difficult to treat calcified stenosis, including calcified stenosis that is anticipated to exhibit resistance to full balloon dilation or subsequent uniform coronary stent expansion. According to the applicant, energizing the lithotripsy device generates intermittent sound waves within the target treatment site, disrupting calcium within the lesion and allowing subsequent dilation of a coronary artery stenosis using low balloon pressure. According to the applicant, the Coronary IVL System is comprised of the following components: 1) IVL Generator –a portable, rechargeable power source that is capital equipment and reusable. 2) IVL Connect Cable – a reusable cable used to connect the IVL Generator to the IVL Catheter. 3) Coronary IVL Catheter –a sterile, single-use catheter that delivers intravascular lithotripsy within the target coronary lesion.

HCPCS CODES REPORTED WITH CORONARY IVL

HCPCS Code Short Descriptor SI APC

92928 Prq card stent w/angio 1 vsl J1 5193 92929 Prq card stent w/angio addl N 92933 Prq card stent/ath/angio J1 5194 92934 Prq card stent/ath/angio N 92941 Prq card revasc mi 1 vsl C 92943 Prq card revasc chronic 1vsl J1 5193 92944 Prq card revasc chronic addl N C9600 Perc drug-el cor stent sing J1 5193 C9601 Perc drug-el cor stent bran N C9602 Perc d-e cor stent ather s J1 5194 C9603 Perc d-e cor stent ather br N C9606 Perc d-e cor revasc w ami s C C9607 Perc d-e cor revasc chro sin J1 5194 C9608 Perc d-e cor revasc chro add N

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