New physician Medicare payments for the Agent drug-coated balloon set for 2027
Boston Scientific said it was able to secure two current procedural technology (CPT) category III codes for the Agent Drug-Coated Balloon (DCB) that are set to become permanent category I CPT codes for use with physician payments starting Jan. 1, 2027.
CPT III codes are temporary and designed to track the usage of new technologies. But the CPT Editorial Summary of Actions published in May confirmed the transition of these temporary codes for DCB to permanent CPT I codes in 2027. These are used in billing to assign relative value units (RVUs) to a physician for payment.
The Agent DCB delivers paclitaxel to treat in-stent restenosis (ISR) and avoids the need for additional metallic stents in the lesion.
CMS has already approved new incremental facility reimbursements for both inpatients and outpatients using the Agent DCB.
The transitional pass-through payment (TPT) is an incremental facility reimbursement for traditional Medicare fee for service patients in the outpatient setting for a three year term, which went into effect Jan. 1, 2025. The reimbursement can cover up to 100% of the device costs.
To receive the TPT payment, hospitals need to report C9610 on outpatient claims for cases using Agent DCB, along with the code for the associated procedure.
CMS also recently added a new technology add-on (NTAP) payment under the Inpatient Prospective Payment System (IPPS) effective Oct. 1, 2025. This applies to Medicare patients in the impatient setting with stays longer than two nights. It is in place for a two year term. NTAP is a procedure based reimbursement and covers up to 65% of the device costs, but is capped at $4,014. It is designed to allow additional payment if there is a difference between the diagnosis-related group (DRG) payment and hospital's reported cost for the discharge.
To receive the NTAP, hospitals must report one of the ICD-10-PCS codes for Agent DCB on inpatient claims.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]