evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Cardioverter- defibrillator, other than single or dual chamber (C1882)  - Includes cardiac resynchronization devices.   Coated stent (C1874, C1875)  - Refers to a stent bonded with drugs (e.g., heparin), layered with biocompatible substances (e.g., phosphorylcholine), or with silicone or a silicone derivative (e.g., PTFE, polyurethane).   Connective tissue, human (C1762)  - These tissues include a natural, cellular collagen or extracellular matrix obtained from autologous rectus fascia, decellularized cadaveric fascia lata, or decellularized dermal tissue. They are intended to repair or support damaged or inadequate soft t issue. They are used to treat urinary incontinence resulting from hypermobility or Intrinsic Sphincter Deficiency (ISD), pelvic floor repair, or for implantation to reinforce soft tissues where weakness exists in the urologi cal anatomy. Note this excludes those items that are used to replace skin. For reporting mesh when used to treat urinary incontinence, see the category Mesh. For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category Urinary incontinence repair device.
(Medicare Claims Processing Manual)
Connective tissue, non -human (includes synthetic) (C1763)  - These tissues include a natural, acellular collagen matrix typically obtained from porcine or bovine small intestinal submucosa, or pericardium. This bio- material is intended to repair or support damaged or inadequate soft tissue. They are used to treat  urinary incontinence resulting from hypermobility or Intrinsic Sphincter Deficiency (ISD), pelvic floor repair, or for implantation to reinforce soft tissues where weakness exists in the urological or musculoskeletal anatomy. [This excludes those items that are used to replace skin.] [For reporting mesh when used to treat urinary incontinence, see the category Mesh.] [For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category Urinary incontinence repair device.]   Cool -tip electrophysiology catheter (C2630)  - Ablation catheter that contains a cooling mechanism and has temperature sensing capability.   Covered stent (C1874, C1875)  - Refers to a stent layered with silicone or a silicone derivative (e.g., PTFE, polyurethane).   Drainage catheter (C1729)  - Intended to be used for percutaneous drainage of fluids. (NOTE: This category does NOT include Foley catheters or suprapubic catheters. Refer to category C2627 to report suprapubic catheters.)   Electrophysiology catheter (C1730, C1731, C1732, C1733, C2630)  - Assists in providing anatomic and physiologic information about the cardiac electrical conduction system. Electrophysiology catheters are categorized into two main groups:  (1) diagnostic catheters that are used for mapping, pacing, and/or recording only, and  (2) ablation (therapeutic) catheters that also have diagnostic capability.  The electrophysiology ablation catheters are distinct from non- cardiac ablation catheters.
(Medicare Claims Processing Manual)
Electrophysiology catheters designated as "cool -tip" refer to catheters with tips cooled by infused and/or circulating saline. Catheters designated as "other than cool -tip" refer to the termister tip catheter with temperature probe that measures temperatur e at the tissue catheter interface.   Embolization protective system (C1884)   A system designed and marketed for use to trap, pulverize, and remove atheromatous or thrombotic debris from the vascular system during an angioplasty, atherectomy, or stenting procedure.  Endoscope, single -use (i.e. disposable), Upper GI, imaging/illumination device (insertable) (C1784)  - Single -use (i.e.,disposable) endoscope with imaging, illumination, and working channels. This single -use (i.e., disposable) endoscope can be used for procedures that take place in the Upper Gastrointestinal (GI) tract.  Extension for a pacing lead (C1883) - Provides additional length to an existing pacing lead but does not have the capability of an adaptor.   Extension for a neurostimulator lead (C1883)  - Conducts electrical pulses from the power source (generator or neurostimulator) to the lead. The terms neurostimulator and generator are used interchangeably.   Guiding catheter (C1887)  - Intended for the introduction of interventional/diagnostic devices into the coronary or peripheral vascular systems. It can be used to inject contrast material, function as a conduit through which other devices pass, and/or provide a mechanism for measu ring arterial pressure, and maintain a pathway created by the guide wire during the performance of a procedure.
(Medicare Claims Processing Manual)
Infusion pump, non -programmable, temporary (implantable) (C2626)  - Short -term pain management system that is a component of a permanent implantable system used for chronic pain management.  Integrated keratoprosthesis (C1818)  The device is composed of a flexible, one -piece biocompatible polymer. It is used to replace diseased corneas in conditions and patient states where traditional corneal transplantation is not indicated or possible. Implantation of the procedure is done i n a two -stage surgical approach.   Intraocular lens (new technology) (C1780)  - Refers to the intraocular lenses approved by CMS as "new technology IOL." A list of these lenses is published periodically in the Federal Register. The latest publication can be found on page 25740 of the Federal Register notice dated May 3, 2000.  Intraoperative ocular device for detached retina (C1784) -  A perfluorocarbon substance instilled during a vitreoretinal procedure to treat detached retina.   Joint device (C1776)  - An artificial joint that is implanted in a patient. Typically, a joint device functions as a substitute to its natural counterpart and is not used (as are anchors) to oppose soft tissue -to-bone, tendon- to-bone, or bone -to-bone.   Left ventricular coronary venous system lead (C1900)  - Designed for left heart placement in a cardiac vein via the coronary sinus and is intended to treat the symptoms associated with heart failure. This code should be reported with CPT codes 33224 or 33225.   Liquid pulmonary sealant (C2615) -  An absorbable, synthetic solution that forms a seal utilizing a photochemical polymerization process. It is used to seal visceral pleural air leaks incurred during pulmonary resection.   Material for vocal cord medialization, synthetic (C1878)  - Synthetic material that is composed of a non- absorbable substance such as silicone and can be injected or implanted to result in vocal cord medialization.
(Medicare Claims Processing Manual)
Material for vocal cord medialization, synthetic (C1878)  - Synthetic material that is composed of a non- absorbable substance such as silicone and can be injected or implanted to result in vocal cord medialization.   Mesh (C1781)  - A mesh implant or synthetic patch composed of absorbable or non-absorbable material that is used to repair hernias, support weakened or attenuated tissue, cover tissue defects, etc. [For reporting connective tissue (human or non- human) when used to trea t urinary incontinence, see the category Connective tissue, human or Connective tissue, non- human.] [For reporting urinary incontinence repair device when used to treat urinary incontinence, see the category Urinary incontinence repair dev ice.]   Morcellator (C1782)  - Used for cutting, coring, and extracting tissue in laparoscopic procedures. These are distinct from biopsy devices because morcellators are used for the laparoscopic removal of tissue.   Pacemaker, other than single or dual chamber (C2621)  - Includes cardiac resynchronization devices as well as other pacemakers that are neither single or dual chamber.   Patient programmer (C1787) - Programmer that allows the patient to operate their neurostimulator, for example, programming the amplitude and rate of stimulation of a neurostimulator system. Only a non- console patient programmer is eligible for transitional pass- through payments.   Peel-away introducer/sheath (C1892) - A non- absorbable sheath or introducer that separates into two pieces. This device is used primarily when removal of the sheath is required after a catheter or lead is in the desired position.   Retinal tamponade device, silicone oil (C1814)   A device used as a permanent/prolonged retinal tamponade in the treatment of complex retinal detachments. This is used as a post -operative retinal tamponade following vitreoretinal surgery.
(Medicare Claims Processing Manual)
Retrieval device, insertable (C1773)  - A device designed to retrieve other devices or portions thereof (e.g., fractured catheters, leads) lodged within the vascular system. This can also be used to retrieve fractured medical devices or to exchange introducers/sheaths.   Septal defect implant system (C1817) - An intracardiac metallic implant used for closure of various septal defects within the heart. The septal defect implant system includes a delivery catheter. The category code for the septal defect implant system (C1817) includes the delivery catheter; t herefore, the delivery catheter should not be reported separately.   Stents with delivery system (C1874, C1876, C2625) -  Stents packaged with delivery systems generally include the following components: stent mounted or unmounted on a balloon angioplasty catheter, introducer, and sheath. These components should not be reported separately.   Temporary non -coronary stent (C2617, C2625)  - Usually composed of a substance, such as plastic or other non -absorbable material, designed to permit removal. Typically, this type of stent is placed for a period of less than one year.   Tissue marker (C1879)  - A material that is placed in subcutaneous or parenchymal tissue (may also include bone) for radiopaque identification of an anatomic site. These markers are distinct from topical skin markers, which are positioned on the surface of the skin to serve as anatomical landmarks.   Transluminal angioplasty catheter (C1725, C1885) -  Designed to dilate stenotic blood vessels (arteries and veins). For vascular use, the terms balloon dilatation catheter and translumina l angioplasty catheter are frequently used interchangeably. [For the reporting of non- vascular balloon dilatation catheters, see the category "Balloon dilatation catheter" (C1726).]   Transvenous VDD single pass pacemaker lead (C1779) -  A transvenous pacemaker lead that paces and senses in the ventricle and senses in the atrium.
(Medicare Claims Processing Manual)
Transvenous VDD single pass pacemaker lead (C1779) -  A transvenous pacemaker lead that paces and senses in the ventricle and senses in the atrium.   Urinary incontinence repair device (C1771, C2631) -  Used to attach or insert a sling graft for the purpose of strengthening the pelvic floor. It consists of the device components used to deliver (suprapubically or transvaginally) and/or fixate (via permanent sutures or bone anchors) the sling graft. The device may or may not be packaged with a sling graft. Report the appropriate category for a device with or without a sling graft. NOTE: For reporting connective tissue (human or non-  human) when used to trea t urinary incontinence, see the category Connective tissue, human (C1762) or Connective tissue, non- human (C1763). For reporting mesh when used to treat urinary incontinence, see the category Mesh (C1781).   Vascular closure device (implantable /insertable) (C1760)  - Used to achieve hemostasis at arterial puncture sites following invasive or interventional procedures using biologic substances (e.g., collagen) or suture through the tissue tract.   Vector mapping catheter (C1732)  - Refers to an electrophysiology catheter with an "in-plane" orthogonal array of electrodes. This catheter is used to locate the source of a focal arrhythmia.    60.5 - Services Eligible for New Technology APC Assignment and Payments (Rev. 3941; Issued: 12- 22-17; Effective: 01 - 01-18; Implementation: 01 -02-18) Under OPPS, services eligible for payment through New Technology APCs are those codes that are assigned to the series of New Technology APCs published in Addendum A of the latest OPPS update.  As of January 1, 2018, the range of New Technology APCs include     APCs 1491 through 1500  APCs 1502 through 1537  APCs 1539 through 1585  APCs 1589 through 1599, and  APCs 1901 through 1908
(Medicare Claims Processing Manual)
 APCs 1491 through 1500  APCs 1502 through 1537  APCs 1539 through 1585  APCs 1589 through 1599, and  APCs 1901 through 1908   OPPS considers any HCPCS code assigned to the above APCs to be a new technology procedure or service.   Application procedures for consideration as a New Technology procedure or service may be found on the CMS Web site, currently at https://www.cms.gov/Medicare/Medicare -Fee-for-Service -Payment/HospitalOutpatientPPS/passthrough_payment.html .  Under the Downloads section, refer to the document titled For a New Technology Ambulatory Payment Classification (APC) Designation under the Hospital Outpatient Prospective Payment System (OPPS) for information on the requirements for submitting an application.  The list of HCPCS codes and payment rates assigned to New Technology APCs can be found in Addendum B of the latest OPPS update regulation each year at  https://www.cms.gov/Medicare/Medicare -Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum -A-and-Addendum -B-Updates.html. Please note that this link may change depending on CMS Web design requirements   61 - Billing for Devices Under the OPPS  (Rev. 1657, Issued: 12- 31-08, Effective: 01 -01-09, Implementation: 01 -05-09)  Future updates will be issued in a Recurring Update Notification.
(Medicare Claims Processing Manual)
61.1 - Requirement that Hospitals Report Device Codes on Claims on Which They Report Specified Procedures  (Rev. 11305; Issued: 03- 24-22; Effective: 04-01-22; Implementation: 04 -04-22) Effective January 1, 2005, hospitals paid under the OPPS (bill types 12X and 13X) that report procedure codes that require the use of devices must also report the applicable HCPCS codes and charges for all devices that are used to perform the procedures where such codes exist and are designated with a status indicator of N (for packaged payment) or H (for pass -through device payment) in the OPPS Addendum B that applies to the date of service. If there are device HCPCS codes with status indicators other than  N or H that describe devices that are used to perform the procedure or that are furnished because they are necessary for the function of an implanted device, hospitals should report the charges for those other devices on an uncoded revenue code line, but should not report the HCPCS codes for those items. Typically, payment for the costs of all internal and external components required for the function of a nonpass -through device is packaged into the APC payment for the associated procedure in which the  device is used. Accurate reporting of HCPCS codes and charges for these internal and external device components is necessary so that the OPPS payment for the associated procedures will be correct in future years in which the claims are used to set the APC  payment rates.  For procedure codes that require the use of devices that are not described by a specific HCPCS code, hospitals should report HCPCS code C1889 (Implantable/insertable device, not otherwise classified) and charges for all devices that are used to perform the  procedures. Such devices must:   Have received FDA marketing authorization, have received an FDA investigational device exemption (IDE) and have been classified as a Category B device by FDA in accordance with 405.203 through 405.207 and 405.211 through 405.215, or meets another appropr iate FDA exemption from premarket review;   Be an integral part of the service furnished;   Be used for one patient only;   Come in contact with human tissue;   Be surgically implanted or inserted (either permanently or temporarily); and   Not be either of the following:  (a) Equipment, an instrument,
(Medicare Claims Processing Manual)
furnished;   Be used for one patient only;   Come in contact with human tissue;   Be surgically implanted or inserted (either permanently or temporarily); and   Not be either of the following:  (a) Equipment, an instrument, apparatus, implement, or item of the type for which depreciation and financing expenses are recovered as depreciable assets as defined in Chapter 1 of the Medicare Provider Reimbursement Manual (CMS Pub. 15-1); or  (b) A material or supply furnished to a service (for example, a suture, customized surgical kit, scalpel, or clip, other than a radiological site marker).  Manufacturers frequently package a number of individual items used with a device in a particular procedure. In cases of devices that are described by device category HCPCS codes whose pass -through status has expired, or HCPCS codes that describe devices without pass -through status, and that are packaged in kits with other items used in a particular procedure, hospitals may consider all kit costs in their line -item charge for the associated device/device category HCPCS code that is assigned status indicator N for packaged payment. That is, hospitals may report the total charge for the whole kit with the associated device/device category HCPCS code. Payment for device/device category HCPCS codes without pass -through status is packaged into payment for the procedures in which they are used, and these codes are assigned status indicator N. In the case of a device kit, should a hospital choose to report the device charge alone under a device/device category HCPCS code with SI=N, the hospital should report charges for other items that may be included in the kit on a separate line on the clai m. Hospitals may use the same revenue code to report all components of the kit.
(Medicare Claims Processing Manual)
61.2 - Edits for Claims on Which Specified Procedures are to be Reported With Device Codes and For Which Specific Devices are to be Reported With Procedure Codes  (Rev. 3685, Issued: 12- 22-16, Effective: 01 -01-17, Implementation: 01- 03-17)  The OCE will return to the provider any claim that reports a HCPCS code for a device -intensive procedure that does not also report at least one device HCPCS code required for that procedure.  If the claim is returned to the provider for failure to pass the  edit, the hospital will need to modify the claim by either correcting the procedure code or ensuring that one of the required device codes is on the claim before resubmission.  While all devices that have device HCPCS codes and that were used in a given p rocedure should be reported on the claim, only one of the possible device codes is required to be on the claim for payment to be made, unless otherwise specified.  The device edit does not apply to the specified procedure code if the provider reports one of the following modifiers with the procedure code:   52 - Reduced Services;  73 - Discontinued outpatient procedure prior to anesthesia administration; and 74 - Discontinued outpatient procedure after anesthesia administration.  Where a procedure that normally requires a device is interrupted, either before or after the administration of anesthesia if anesthesia is required or at any point if anesthesia is not required, and the device is not used, hospitals should report modifier 52, 73 or 74 as applicable.  The device edit is not applied in these cases.   The OCE will also return to the provider claims for which specified devices are billed without the procedure code that is necessary for the device to have therapeutic benefit to the patient.  If the claim is returned to the provider for failure to pass the edit, the hospital will need to modify the claim by either correcting the device code or ensuring that one of the required procedure codes is on the claim before resubmission.      61.2.1  Bypass Edit Modifier CG for Claims on Which Specified Procedures are to be Reported With Device Codes                            (Rev.4513, Issued: 02- 04-2020, Effective: 01 -01- 2020, Implementation: 01- 06-2020)
(Medicare Claims Processing Manual)
For certain device -intensive procedures, providers may bypass the device edit requiring at least one device HCPCS code for the procedure. For situations where no device was performed with certain device -intensive procedures, providers may bypass the edit b y reporting modifier CG.   61.2.2  Edit for Level 6 Intraocular Procedures APC  (Rev.  12552; Issued:03- 21-24; Effective:04 -01-24; Implementation:04 -01-24)  Effective CY 2024, the OCE will return to providers claims that report a procedure code assigned to APC 5496  Level 6 Intraocular Procedures  but do not report the correct device code that must be implanted during the procedure. The device code must corr ectly reflect the type of device that was implanted during the procedure. The table below displays the procedures assigned to the Level 6 Intraocular Procedures APC as well as the appropriate device code that must be present on the claim for that procedure . Hospitals may not bypass this edit by reporting modifier CG.   APC 5496 CPT Codes  Long Descriptor  Device HCPCS Code to Report with CPT code  Long Descriptor  0308T  Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis C1840  Lens, intraocular (telescopic)  0616T  Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens  C1839  Iris prosthesis 0617T  Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and insertion of C1839  Iris prosthesis intraocular lens  0618T  Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchange  C1839  Iris prosthesis  This edit does not apply if the provider reports one of the following modifiers with the procedure code:   52  Reduced Services;  73  Discontinued outpatient procedure prior to anesthesia administration; and 74  Discontinued outpatient procedure after anesthesia administration.