Medtronic Cardiac Rhythm Management Products

1、Medtronic Cardiac Rhythm Management ProductsMedicare Category Pass-Through CodesUpdated August 6, 2002The Benefits Improvement and Protection Act (BIPA), enacted on December 21, 2000, required a change in the payment methodology for pass-through devices. Effective April 1, 2001, the item-specific me

2、thod of payment was changed to a system of payment based on categories of devices. The following list of Medtronic products for Cardiac Rhythm Management provides the category pass-through codes. Determining which category code is applicable for a specific item is the responsibility of the hospital.

3、 For further information, please contact Medtronics reimbursement professionals at 763-514-8892 or 800-328-2518, extension 4-8892.C1785Pacemaker, Dual Chamber, Rate Responsive (Implantable) Brand NameModel NumberKappa 900 DRKDR 901, KDR 903, KDR906, KDR 921, KDR 92100, KDR 931, KDR 933Kappa 800 DRKD

4、R 801, KDR 803, KDR 806Kappa 700 DRKDR 700, KDR 701, KDR 703, KDR 706, KDR 720, KDR 721, KDR 730, KDR 731, KDR 733Kappa 400 DRKDR 401, KDR 403Selection AFm 902902Diamond 3 DR840Diamond II DR820E, 822EKappa 650 DRKDR651, KDR 653, KDR656Kappa 600 DRKDR 600, KDR 601, KDR 603, KDR 606Vita 2 DR830Vita DR

5、810 Sigma 300 DRSDR303B, SDR303U, SDR306USigma 200 DRSDR203BLegacy II DR828, 826Clarity DR860, 862, 865Thera DR 7940, 7941, 7942, 7950, 7951, 7952, 7960i, 7961i, 7962i, 7964i, 7965i, 7966i, 7968i Preva DR7088, 7089Prodigy DR7860, 7861, 7862Legacy DR850, 851, 852C1786Pacemaker, Single Chamber, Rate R

6、esponsive (Implantable) DeviceModel NumberKappa 900 SRKSR 901, KSR 903, KSR 906, KSR 90100Kappa 700 SRKSR 700, KSR701, KSR703, KSR706Kappa 400 SRKSR401, KSR403Topaz 3 SR 540Topaz II SR520, 521, 522 Sigma 300 SRSSR303B, SSR303U, SSR306UVita 2 SR530Vita SR310, 415Sigma 200 SRSSR203BLegacy II SR526, 52

7、8 Clarity SR560, 562, 565Prodigy SR8158, 8160, 8161, 8162Thera SR8940, 8941, 8942, 8960i, 8961i, 8962iPreva SR8088, 8089Legacy SR550, 551, 552C2619Pacemaker, Dual Chamber, Non Rate-Responsive (Implantable) DeviceModel Number Kappa 700 DKD700, KD701, KD703, KD706Ruby 3 DRuby 3 DRuby II DDD720 Sigma 3

8、00 DSD303BSigma 200 DSD203BLegacy II D728, 726Thera D7944, 7945, 7946, 7964i, 7965i, 7966iPreva D7068Legacy D750, 751Vita D710Prodigy D7864, 7865, 7866Kappa 900 VDDKVDD 901 Kappa 700 VDDKVDD700, KVDD701Sigma 300 VDDSVDD303Thera VDD8948, 8968iProdigy VDD8168 Vita VDD 410C2620Pacemaker, Single Chamber

9、, Non Rate-Responsive (Implantable) DeviceModel NumbersPremier8081Sigma 300 SSS303BJade 3 S340Jade II SSI220 Sigma 200 SSS203Legacy II S126, 128, Sigma 100 SSS103B, SS106UThera S 8944, 8945, 8946, 8964i, 8965i, 8966i Prevail8084, 8085, 8086Legacy S 150, 151, 152Prodigy S 8164, 8165, 8166C2621Pacemak

10、er, Other Than Single or Dual Chamber (Implantable) DeviceModel NumbersInSync8040C1900Lead, Left Ventricular Coronary Venous SystemDeviceModel NumbersAttain OTW 4193Attain LV2187Attain CS/CV2188C1898Lead, Pacemaker, Other Than Transvenous VDD Single PassDeviceModel NumbersCapSure Sense 4074, 4574, 4

11、073CrystallineICM09B, ICM09JB, ICM09CapSure Z Novus5054, 5554CapSure Z4033, 4034, 4533, 4534, 5033, 5034, 5544, 5554Impulse IIIHP09B, IHP09JBImpulseIMG49, IMG49B, IMG49JBCapSure SP Novus4092, 4592, 5092, 5592, 5594CapSure SP4023, 4024, 4523, 4524, 5023, 5023M, 5024, 5024M, 5523, 5523M, 5524, 5524M,

12、5525CapSure4003, 4003M, 4004, 4004M, 4503, 4503M, 4504, 4504M, 5025, 5026, 5525Excellence + IMD49, IMD49B, IMD49JB Excellence S+IME49, IME49B, IME49JBExcellence PS+IMK49B, IMK49JBExcellence SS+IML49B, IML49JBCapSureFix Novus5076CapSureFix4067, 4068, 4568, 5058, 5067, 5068, 5568 (bipolar)SureFix5072P

13、irouet + IMU49, IMU49B, IMU49JB, Pirouet S+IMX49, IMX49B, IMX49JB Crystalline ActFixICF09 CapSure Epi49684057M, 4058M, 4557M, 4558M, 5058 4057M, 4058M, 4557M, 4558M, 5058 C1779Lead, Pacemaker, Transvenous VDD Single PassDeviceModel NumbersCapSure VDD5032, 5032L, 5032S, 5038, 5038, 5038L, 5038SC1721C

14、ardioverter-Defibrillator, Dual Chamber (Implantable) Device Model NumbersMarquis DR7274Jewel AF7250Gem III DR7275Gem II DR7273Gem DR7271C1722Cardioverter-Defibrillator, Single Chamber (Implantable) Device Model NumberGem III VR7231Gem II VR7229CxGem7227, 7227 B, 7227D, 7227E, 7227CxC1882Cardioverte

15、r-Defibrillator, Other Than Single or Dual Chamber (Implantable)Device Model NumbersInSync ICD 7272Gem III AT7276Micro Jewel7221B, 7221Cx, 7221EMicro Jewel II7223CXC1777 Lead, Cardioverter-Defibrillator, Endocardial Single Coil (Implantable)DeviceModel NumberSprint6932, 6943C1895Lead, Cardioverter-D

16、efibrillator, Endocardial Dual Coil (Implantable)DeviceModel NumberSprint Quattro Secure6947Sprint Quattro6944Sprint6942, 6945C1896Lead, Cardioverter-Defibrillator, Other Than Endocardial Single or Dual Coil (Implantable)DeviceModel Number6996 SQ6996Transvene6881, 6884, 6895, 6933, 6934S, 6936, 6937

17、, 6939, 6963, 6966, 6999Oval Patch Leads6721L, 6721M, 6721S, 6939 CapSure Fix6940, 4068CapSure Epi4965CapSure SP5024M-110 4951M, 50714951M, 5071C1764Event Recorder, Cardiac (Implantable)DeviceModel NumberReveal, Reveal Plus9525, 9526C1730Catheter, Electrophysiology, Diagnostic, Other Than 3D Mapping

18、 (19 or Fewer Electrodes)DeviceModel NumberTorqr CSTorqr, SoloistMarinr CSMarinrC1731Catheter, Electrophysiology, Diagnostic, Other Than 3D Mapping (20 or More Electrodes)DeviceModel NumberStable Mapr SM04401SM47, 04402SM47C1733Catheter, Electrophysiology, Diagnostic/Ablation, Other Than 3D or Vecto

19、r Mapping, Other Than Cool TipDeviceModel NumberRF Enhancer11744523, 11745523, 11745533, 19745533, 19746534, 21744523, 21745523, 29745533, 29746534RF Contactr70246034, 70247533, 70256034, 70257533RF Conductr 078754447, 0786022, 0786042, 0787533, 0787544, 07857544, 07856042 07856044, 078604447RF Mari

20、nr MC075302, 075305, 075402, 075405, 0753125F RF Marinr076583, 076584, 076585, 076586, 076514, 076515RF Performr8715352247, 8715452347, 8715552347, 8715553347, 8795553347, 8795653447C1769Guide WireDeviceModel NumberAttain LDS Guide Wire Item is a component of the Attain LDS Model 6216 and 6216AAttai

21、n Access Guide WireItem is a component of the Attain Access Model 6218 and 6218AC1883Adaptor / Extension, Pacing Lead (Implantable)DeviceModel NumberAdaptor 2872, 5866-09M, 5866-21, 5866-24M, 5866-36, 5866-37M, 5866-38M, 5866-40M, 6707, 6726-5C1887Catheter, Guiding (may include infusion/perfusion capability)DeviceModel NumberAttain LDS Guide CatheterItem is a component of the Attain LDS Model 6216 and 6216AAttain Access Guide CatheterItem is a comp