Technical Mastery: Guidance on Proper Imaging, Lesion Preparation, and Deployment for Coronary Drug-Coated Balloons. Part 1: In-Stent Restenosis, Step-by-Step How to Treat-DCB Billing and Reimbursement, Monica Wright

DCB Billing and Reimbursement, Monica Wright

Video Transcription

Video Summary

Monica Wright from Sky explains billing and coding for drug-coated balloons (DCB) in cardiology, focusing on two category III CPT codes (0913T and 0914T) which currently face reimbursement challenges as they lack consistent payer payment. Major insurers like Humana support payment, while smaller payers may not. Facilities can receive payments through inpatient New Technology Add-On Payment (NTAP) and outpatient Traditional Pass-Through Payment (TPT). Category I CPT codes for DCB are expected in 2027, improving payment consistency. Providers are encouraged to use prior authorizations, crosswalks, and appeals to secure reimbursement, and stay informed on payer policies.

Keywords

drug-coated balloons

category III CPT codes

reimbursement challenges

New Technology Add-On Payment

prior authorizations