Billing for ECP treatment

ECP's crucial role in noninvasive cardiac treatment is being recognized by a growing number of commercial carriers. Current reimbursement rates vary from state to state, and range between $230-600 per hour of treatment.

The CPT code for commercial reimbursement is: 92971 - External Cardio Assist method of circulatory assist, The Medicare code is G0166

There are additional reimbursable procedures associated with ECP, and your local representative will provide you with further details.

Reimbursement Rate

Empire Medicare Services' published 2003 reimbursement fee schedule indicates the CPT code for ECP (G0166) at $232.72 (participating fee) and $221.08 (non participating). This reflects an increase in reimbursement of 27% since 2002.

Qualifying diagnostic procedures

ECP treatment requires pre and post treatment diagnostics. These include:

• Nuclear stress test (pre and post)
• Abdominal ultrasound
• Echocardiogram
• Vascular arterial and venous studies

For complete clinical guidelines, contact an MSO representative by calling (201) 670-9999