Vasomedical, Inc. - EECP® Therapy | Physicians

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Reimbursement

As part of Vasomedical’s commitment to advancing patient access to EECP® therapy, we work directly with the Centers for Medicare and Medicaid Services (CMS), public and private health insurers, and industry stakeholders to ensure appropriate reimbursement for services involving our products. Patients should contact their primary care physician, cardiologist or local EECP therapy center to discuss eligibility for treatment and reimbursement coverage.

CMS – Centers for Medicare and Medicaid Services

Section 20.20 (formerly 35-74) of the Medicare Coverage Issues Manual was revised to provide national Medicare coverage for external counterpulsation (ECP). The Centers for Medicare and Medicaid Services currently covers treatment with EECP therapy/ECP systems for patients who have been diagnosed with disabling stable angina (Class III or IV Canadian Cardiovascular Society or equivalent classification), who in the opinion of a cardiologist or cardiothoracic surgeon, are not readily amenable to surgical intervention because:

Their condition is inoperable, or at high risk of operative complications or postoperative failure;
Their coronary anatomy is not readily amenable to such procedures; or
They have co-morbid states, which create excessive risk.

Patients with stable congestive heart failure of ischemic etiology are covered under the aforementioned policy if they present with concomitant angina pectoris or angina equivalent symptoms. Coverage for congestive heart failure of idiopathic etiology is not currently provided under Medicare. The Centers for Medicare and Medicaid Services provide additional information on reimbursement. You can search for both national and local coverage decisions on the CMS website, including information on the national coverage decision (NCD) for external counterpulsation.

Private Insurance

Third party commercial insurance carriers offer reimbursement for EECP therapy and have established coverage criteria similar to Medicare. Currently over 300 third-party payers cover EECP treatment.

Physician

Code	Procedure	2008 National Average Medicare Payment Rate	Other Information
G0166	HCPCS Level II Code for external counterpulsation, per treatment session	$156.16	G0166 is a Medicare specific code. However, some private payers accept this procedure code and provide reimbursement. Please verify that this code is accepted with private payers before billing it.
G0166-76	Same as above		When a patient receives two, one-hour sessions in one day, then the suffix -76 is typically used for clarification.
93799	CPT® Code for unlisted cardiovascular service or procedure		Some Medicare carriers require the use of this code with G0166 when two treatments are administered to a patient on the same day of service. Consult local Medicare carrier guidelines.
92971	CPT Code for Cardioassist-method of circulatory assist; external		Since an individual CPT code has not yet been assigned for EECP, some private payers that do not accept G0166 allow 92971.

Outpatient Hospital

Reference	Ambulatory Patient Classification	Procedure	2008 Average Medicare Payment Rate	Other Information
G0166	0678	External counterpulsation, per treatment session	$109.47	Private payer classification and payment will be based on individual facility contracts with payers and will vary among payers and insurance plans/products. Providers should review their individual contracts to determine terms for payment and claims processing requirements.