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Reimbursement Resources

U.S. Reimbursement & Coding Guide for Select Bronchoscopy Procedures

Medicare National Payment Rates

 

 

We have provided the following reimbursement resources related to FDA-cleared indications for use of the Galaxy System™. If you are a healthcare professional with coding questions beyond the information provided, please contact us for further assistance. 
REIMBURSEMENT & CODING GUIDE

Transitional Pass-Through (TPT)

Payment Overview

 

The TPT Program is intended to facilitate Medicare beneficiary access to new and innovative medical devices. The TPT program provides incremental payment in addition to the standard Medicare hospital outpatient Ambulatory Payment Classification (APC) payment for the related procedure.
 
TPT and Disposable Pulmonary Bronchoscopes
  • Effective January 1, 2024 CMS awarded TPT status to qualifying single-use pulmonary bronchoscopes utilized in select procedures1
  • Each hospital is responsible for determining whether a particular device qualifies for TPT payment.
  • A third party legal analysis concluded that the Galaxy Bronchoscope appears to meet the criteria for TPT payment.2
  • This status is set to last for 3 years.
 
What is the new HCPCS Code and Device Category?
  • HCPCS Code: C1601
  • Device Category: Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)

coding process

coding table

*CPT 31628 and 31629 are two of several procedural codes that can be billed with C1601. The full list of procedures is in Transmittal 12421, Change Request 13488, Dec. 23, 2023, https://www.cms.gov/files/document/r12421cp.pdf.1)Transmittal 12421, Change Request 13488, Dec. 21, 2023, https://www.cms.gov/files/document/r12421cp.pdf2) https://noahmedical.showpad.com/share/CCU2m6iJp7egXScz6y3s4

 

If you have questions regarding reimbursements, email us at reimbursement@noahmed.com.

 

The coding and payment information contained in this document is gathered from various resources and is subject to change without notice. Noah Medical cannot guarantee success in obtaining coverage and reimbursement for any procedure or device. It is always the provider’s responsibility to determine and submit appropriate codes and charges for the items and services they furnish. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies. CPT only copyright 2023 American Medical Association. All rights reserved.