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By Larry Storer

The U.S. Centers for Medicare and Medicaid Services have published the final fee schedule for new Current Procedural Terminology (CPT) Category 1 codes for BTG International’s  Varithena procedures, and changed CPT codes for Medtronic’s VenaSeal, effective Jan. 1, 2018.

The new codes for Varithena, which close veins through the ultrasound-guided injection of non-compounded foam scleroscant, allow for automated claims adjudication, substantially simplifying and allowing consistent and predictable reimbursement policies for physicians, Medicare and commercial payers.

Also on Jan. 1, Medtronic’s VenaSeal varicose vein closure device will get new CPT codes setting higher billable rates for those procedures, which use cyanoacrylate, a proprietary adhesive, to close an incompetent vein in lower extremities in people suffering from symptomatic venous reflux or varicose veins.

Medtronic has been able to get more favorable rates for its VenaSeal Closure System under the new CPT codes 36482 and 36483 going forward in 2018.



Varithena (polidocanol injectable foam) is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein system above and below the knee. It improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.

Varithena GM Mike Motion said CPT Codes 36465 and 36466 have been assigned to the Varithena procedures.

“CPT Code 36465 is assigned for injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring the treatment of a single, incompetent extremity vein,” Motion said. “A single incompetent extremity truncal vein; for example, the great saphenous vein (GSV) or an accessory saphenous vein (AGSV).”

He said CPT Code 36466 is for the treatment of multiple incompetent truncal veins; for example, the GSV or AGSV in the same leg.

“More than 10,000 Varithena procedures have been performed since its U.S. Food and Drug Administration’s approval in November 2013 and its subsequent commercial launch in August of 2014,” Motion said.

Through the end of 2017, physicians using Varithena had to bill through the unlisted vascular surgery procedural code 37799 in conjunction with the unspecified drug code J3490, and then spend valuable clinical time jumping through hoops to secure reimbursement.

The new codes set reimbursement at $1,624.30 for treatment of a single incompetent extremity vein and $1,697.02 for treatment of multiple incompetent veins in the same leg.

“Having a CPT Code  is important to physicians because it reduces the number of manual claims; allows automatic and electronic processing of claims, which means faster, easier experience; and potentially decreases time to receive payment.,” Motion said.

The new codes treat Varithena as a procedure and a supply, so they will be included in the code and not separately reported. “To be specific: the unspecified J3490 code for the drug is separately reported in 2017 and starting Jan. 1, 2018,” Motion said. “Varithena, as a supply, will be included in the new CPT codes and not separately reported. “



Medtronic’s VenaSeal Closure System received a favorable new CPT code as a level 4 vascular procedure as part of the 2018 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems.

Medtronic spokesperson Julia Baron said Medtronic’s new CPT codes – 36482 and 35483  – bring the device closer to positive coverage from public and private insurers in the United States.

CPT Code 36482, an endovenous thermal chemical adhesive for the first vein with VenaSeal is $2,162 under the CMS national al average payment. Baron said CPT Code 36483 is an add-on code that must be billed in conjunction with 36482 to cover subsequent veins treated in a single extremity, each through separate access sites. Its CMS national al average payment is $147.

Covered as part of the code is the endovenous ablation therapy of the incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated.

“This definitely represents progress for us as we seek positive coverage for VenaSeal,” she said.

Earlier this year, Medtronic released three-year outcomes and one-year data that demonstrated long-term clinical benefits and quality of life improvements for patients.

The procedure, however, remains under a self-pay model since its FDA clearance and U.S. launch in 2015, according to Sandra Lesenfants,  vice president and general manager of Medtronic endoVenous.

“Medtronic has been working to pursue payer coverage, and we will continue to provide updates over the next several months as we work with regional Medicare Administrative Contractors (MACs) and private payers to obtain that coverage,” Lesenfants said.

“While we cannot discuss market share, we do believe payer coverage will provide additional patient access and ultimately drive additional adoption and growth for VenaSeal,” she said.

Medtronic touts VenaSeal as the only non-tumescent, non-thermal and non-sclerosant procedure, so it avoids the risk of nerve injury sometimes associated with certain thermal-based treatments of the small saphenous vein presently in use.

The VenaSeal closure system is also designed to allow rapid recovery with minimal downtime; people may not even need to use compression stockings after undergoing the procedure.



In addition, under the Final Rule (CMS-1678-FC), which addresses the final changes to the amounts and factors used to determine the payment rates for Medicare services paid under the Hospital Outpatient Prospective Payment System (OPPS) and those paid under the Ambulatory Surgical Centers (ASC) payment system, mechanochemical (ClariVein), and laser were reassigned from level 2 to Level 3 Vascular Procedures.

This reassignment reflects the clinical resources needed to perform these procedures. The CPT coding did not change; however, the comprehensive-ambulatory payment category (C-APC) and reimbursement amounts changed from a Medicare National Average of $2,360 (C-APC 5182) to $2,493 (C-APC 5183). VTN



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