CMS Grants Additional Reimbursement forGORE® TAG® Thoracic Branch Endoprosthesis (TBE)
Effective October 1, 2022
New Technology Add-on Payment (NTAP)
The Centers for Medicare and Medicaid Services (CMS) created the NTAP to help ensure hospitals do notincur significant reimbursement shortfalls when adopting innovative new technologies and to facilitate
patient access for qualifying new medical technologies that substantially improve the diagnosis ortreatment of Medicare beneficiaries.
NTAP is additional payment on top of the Medicare Severity-Diagnosis Related Group(MS-DRG) or TRICARE® DRG reimbursement.
Approval granted:§§

Cost criterion: Cost for cases involving TBE “exceeds the case-weighted threshold amount.”
FDA marketing authorization May 13, 2022, for indication covered by its Breakthrough Device
designation for endovascular repair of lesions of the descending thoracic aorta, while maintaining
flow into the left subclavian artery.*

Reporting add-on payment
The International Classification of Diseases 10th Revision Procedure Coding System(ICD-10-PCS) code for reporting will be effective October 1, 2022. Hospitals can report the codes on claim
forms for procedures† related to TBE to receive the add-on payment for eligible inpatient cases.
Details of the NTAP:
Eligiblefacilities

Acute care hospitals participating in the inpatient prospective payment system (IPPS) areeligible. Hospitals under the TRICARE® program are eligible.

Qualifiedpatients

Traditional Medicare and dual-eligible (Medicare-Medicaid) fee-for-service patients orTRICARE® patients whose case totals exceed the MS-DRG rate payment are qualified.

Add-onpayment

NTAP is limited to lesser of 65% of the cost of the new technology or 65% of the amount bywhich the cost of case exceeds the MS-DRG payment.

Payment
amountTotal $27,807 per maximum amount. Effective October 1, 2022.

Duration

NTAP is approved for a minimum of two years and no more than three years; the maximum
add-on payment amount is reassessed annually.

Codingrequirements

ICD-10-PCS Codes: (Both must be reported on claim)
02VX3EZ – Restriction of thoracic aorta, ascending/arch with branched or fenestrated
intraluminal device, one or two arteries, percutaneous approach.
02VW3DZ – Restriction of thoracic aorta, descending with intraluminal device,percutaneous approach.

Reference: https://www.federalregister.gov/documents/2023/08/28/2023-16252/medicare-program-hospital-inpatientprospective-payment-systems-for-acute-care-hospitals-and-the* Refer to Instructions for Use at eifu.goremedical.com for a complete description of
all applicable applications, warnings, precautions and contraindications for the markets
where this product is available.
† Hospitals remain responsible for determining correct coding and reimbursement reporting.

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

Consult Instructionsfor Useeifu.goremedical.com
INDICATIONS FOR USE IN THE U.S.: The GORE® TAG® Thoracic Branch Endoprosthesis is indicated for endovascular
repair of lesions of the descending thoracic aorta, while maintaining flow into the left subclavian artery and have:
Adequate iliac/femoral access; Proximal Aortic Landing Zones: For Isolated Lesion Patients: Proximal landingzone cannot be aneurysmal, dissected, heavily calcified or heavily thrombosed; For Dissection Patients: Primary entry
tear must be distal to the left subclavian artery and the proximal extent of the landing zone must not be dissected;
Aortic inner diameter range 16–42 mm; Proximal segment length (length from distal edge of left subclavian artery to
mid left common carotid ostium) of at least 2.0–4.0 cm, depending on Aortic Component selection; Proximal covered
length (measured from distal edge of left subclavian artery to distal edge of left common carotid artery ostium) of atleast 15–36 mm, depending on Aortic Component selection; For patients with prior ascending aorta or aortic arch repair
with surgical graft: at least 2 cm landing zone proximal to the distal anastomosis; Left Subclavian Landing Zone:
Landing zone cannot be aneurysmal, dissected, heavily thrombosed and severely tortuous (180 degree turn within thetreated length); Left subclavian artery inner diameter of 6–18 mm, depending on Side Branch Portal diameter selected;
Left subclavian artery minimum length of 2.5–3.0 cm, depending on Side Branch Portal diameter selected. Distal
Landing Zone (Isolated Lesion Patients only): Outer curve length must be ≥ 2 cm proximal to celiac artery; Aortic
inner diameter range 16–42 mm; Non aneurysmal, dissected, heavily calcified or heavily thrombosed landing zone;
Native Aorta or previously placed GORE® TAG® Conformable Thoracic Stent Graft. CONTRAINDICATIONS: The GORE®
TAG® Thoracic Branch Endoprosthesis is contraindicated in: Patients with known sensitivities or allergies to the devicematerials [ePTFE (polytetrafluoroethylene), FEP (fluoroethylpropylene), Nitinol (nickel, titanium), Gold, SB Component
only - Heparin (CBAS® Heparin Surface)]; Patients who have a condition that threatens to infect the graft; Patients withknown hypersensitivity to heparin, including those patients who have had a previous incident of Heparin-Induced
Thrombocytopenia (HIT) type II. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all
applicable indications, warnings, precautions and contraindications for the markets where this product is available.
Products listed may not be available in all markets.
TRICARE is a trademark of the Department of Defense (DoD), Defense Health Agency (DHA).
CBAS is a trademark of Carmeda AB, a wholly owned subsidiary of W. L. Gore & Associates, Inc.
GORE, Together, improving life, TAG and designs are trademarks of W. L. Gore & Associates.
© 2022–2023 W. L. Gore & Associates, Inc. 231227063-EN OCTOBER 2023