GORE® EXCLUDER® Thoracoabdominal Branch EndoprosthesisAwarded New Technology Add-on Payment and ICD-10-PCS X-Code
Dear Valued Customer,
We are pleased to inform you that The Centers for Medicare and Medicaid (CMS) have granted
GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis (TAMBE) a New Technology Add-on
Payment1 (NTAP) and a new ICD-10-PCS X-Code2, effective October 1, 2024.
TAMBE is the first and only Food and Drug Administration (FDA) approved, off-the-shelf endovascular device
for the treatment of complex aneurysmal disease involving the visceral aorta.3NTAPCMS created the NTAP to help ensure hospitals do not incur significant reimbursement shortfalls
when adopting innovative new technologies and to facilitate patient access for qualifying new medicaltechnologies that substantially improve the diagnosis or treatment of Medicare beneficiaries.
NTAP is an additional payment on top of the Medicare Severity-Diagnosis Related Group (MS-DRG) orTRICARE® DRG reimbursement.
Details of the NTAP and X-Code:
Eligible facilities
Acute care hospitals participating in the inpatient prospective payment system (IPPS) are eligible hospitals
under the TRICARE® program.
Qualified patients
Traditional Medicare and dual-eligible (Medicare-Medicaid) fee-for-service patients or TRICARE® patients.
Coding requirements
You must include X2VE3SA (New X-Code) for the claim to be NTAP eligible. Assigning the X-Code will allow
accuracy of reporting into the Medicare system database.
NTAP amountUp to a maximum of $47,238.75

TRICARE is a trademark of the Department of Defense, Defense Health Agency (DHA).

W. L. Gore & Associates, Inc.
Medical Products Division3450 West Kiltie LaneFlagstaff, AZ 86001
USA

Asia Pacific +65 67332882
Australia/New Zealand 1800 680 424
Europe 00800 6334 4673
United States +1 800 437 8181
United States +1 928 779 2771
goremedical.com

Duration
Effective October 1, 2024; NTAP is approved for a minimum of 2 years and no more than 3 years; themaximum add-on payment amount is reassessed annually.
The New ICD-10-PCS X-Code▪ The X-Code was assigned for reporting the TAMBE procedure.
▪ The X-Code fully represents the specific procedure described in the code title.

X2VE3SA – New Technology, Cardiovascular System, Restriction, Descending Thoracic Aorta and Abdominal
Aorta, Percutaneous, Branched Intraluminal Device, Manufactured Integrated System, Four or More Arteries,
New Technology Group.
Physician payments
Physicians’ payments will submit their charges on a separate claim. They will report the appropriate
CPT® code for the TAMBE procedure (37799—Unlisted code, vascular surgery). The X-Code will only bereported on the facility claim and will not be reported by physicians.
1.	Medicare, Medicaid, and Children’s Health Insurance Programs: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-TermCare Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates, etc. An unpublished Rule by the Centers for Medicare & MedicaidServices on 08/28/2024. Document Number: 2024-17021. Available August 1, 2024. Accessed August 7, 2024. Federal Register :: Public Inspection: Medicare,Medicaid, and Children’s Health Insurance Programs: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care
Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates, etc.
2.	2025 ICD-10 Procedure Coding System (ICD-10-PCS). Centers for Medicare & Medicaid Services. Accessed July 11, 2025.
https://www.cms.gov/medicare/coding-billing/icd-10-codes/2025-icd-10-pcs
3.	GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis [Instructions for Use]. Flagstaff, AZ: W. L. Gore & Associates, Inc; 2024. MD193085. Rev 1.
Disclaimer: The reimbursement information provided by W. L. Gore & Associates, Inc. (“Gore”) is presented for your convenience and general information purposes
only. The information does not constitute legal advice and is subject to change without notice. The information is obtained from publicly available third-party
sources and does not guarantee coverage or payment for services performed in any procedure utilizing any products manufactured or supplied by Gore.
Gore has used reasonable efforts to ensure the completeness and accuracy of the information contained herein as of the date this document was published. Healthcare providers are responsible for exercising their independent clinical judgment and following specific coverage guidelines and payer directives in selecting thecodes that reflect the patient’s condition and the services provided. Health care providers should contact the individual Medicare contractor or other third-party
payer if they have questions regarding reimbursement. Gore does not promote its products outside of their FDA-cleared or approved labeled indications.

Consult Instructions
for Useeifu.goremedical.com
INDICATIONS FOR USE IN THE U.S.: The GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis is indicated for endovascular repair in patients withthoracoabdominal aortic aneurysms and high-surgical risk patients with pararenal aortic aneurysms who have appropriate anatomy as described below:
Adequate iliac/femoral access and brachial/axillary access; Proximal (supraceliac) aortic neck treatment diameter range over 2 cm seal zone of 22–34 mm foraneurysms extending up to 6.5 cm or less above the origin of the most proximal branch vessel; Aortic neck angle ≤ 60° at the Aortic Component proximal sealzone; Iliac artery treatment diameter range of 8–25 mm and iliac artery seal zone length of at least 10 mm; Renal artery seal zone diameters between 4.0–10.0 mm;
Celiac and superior mesenteric artery seal zone diameters between 5.0-12.0 mm; ≥ 15 mm seal zone length in renal arteries, superior mesenteric artery, and celiac
artery; Visceral segment of aorta (3 cm proximal through 9.5 cm distal to the most proximal visceral artery) must be ≥ 20 mm in diameter. CONTRAINDICATIONS:The GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis is contraindicated in: Patients with known sensitivities or allergies to the TAMBE Device materials
including ePTFE, FEP, nickel titanium alloy (Nitinol), stainless steel, and gold. Patients who have a condition that threatens to infect the graft. Patients with known
hypersensitivity to heparin, including patients who have had a previous incident of Heparin-Induced Thrombocytopenia (HIT) type II and cannot receive theGORE® VIABAHN® VBX Balloon Expandable Endoprosthesis. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicableindications, warnings, precautions and contraindications for the markets where this product is available.

Further questions, coding and detailed hospital-specific calculation can be directed to Gore’s Field
Reimbursement Directors at: +1 800 248 8489 or fieldreimbursementdirectors@wlgore.com.

W. L. Gore & Associates, Inc.
Medical Products Division3450 West Kiltie Lane
Flagstaff, AZ 86001
USAAsia Pacific +65 67332882
Australia/New Zealand 1800 680 424
Europe 00800 6334 4673
United States +1 800 437 8181
United States +1 928 779 2771
goremedical.com

Products listed may not be available in all markets.
CPT® is a registered trademark of the American Medical Association (AMA).
TRICARE is a trademark of the Department of Defense, Defense HealthAgency (DHA).
GORE, Together, improving life, EXCLUDER, VBX, VIABAHN
and designs are trademarks of W. L. Gore & Associates.
© 2024 W. L. Gore & Associates, Inc. 24PR1042-EN01 AUGUST 2024