Payment and Reimbursement Guidelines

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a minimally invasive technique used by the Trauma, Critical Care and Emergency Medicine community to temporarily occlude large vessels using a balloon.

This guide has been developed to assist you in obtaining the appropriate hospital reimbursement and physician payment for services rendered to patients having large vessel occlusion.  We strongly suggest that you consult your payer organizations with regard to local coverage, coding and reimbursement policies.

To comply with Medicare and third-party payer requirements, all physician claim forms must indicate the International Classification of Diseases, 10th Revision (ICD-10) codes that identify diagnoses, symptoms, conditions, problems, complaints, or other reason(s) for the encounter/visit.  A partial list of common diagnoses for patients who may require a REBOA balloon occlusion include:

ICD-10-CM Diagnosis Codes (Partial List)

Abdominal Trauma
S35.222A Major Laceration of Superior Mesenteric Artery, Initial Encounter
S35.212A Major Laceration of Celiac Artery, Initial Encounter
S36.113D Laceration of liver, unspecified degree, subsequent encounter
S36.032 Major laceration of spleen
S36.539A Laceration of unspecified part of colon, initial encounter
S36.029A Unspecified contusion of spleen, initial encounter
Pelvic Fracture             
S32.810A Multiple fx of pelvis w stable disrupt of pelvic ring, initial closed fracture
S32.810B Multiple fx of pelvis w stable disrupt of pelvic ring, initial open fracture
S32.811A Multiple fx of pelvis w unstable disrupt of pelvic ring, initial closed fracture
S32.811B Multiple fx of pelvis w unstbl disrupt of pelvic ring, initial open fracture
Postpartum Hemorrhage
O43.219 Placenta accreta, unspecified trimester
O43.229 Placenta increta, unspecified trimester
O43.239 Placenta percreta, unspecified trimester
O72.1 Other immediate postpartum hemorrhage

ICD-10-PCS Procedure Codes

ICD-10 codes that may be used to describe REBOA procedures (Effective October 1, 2018):

04L03DJ Occlusion of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Approach
02LW3DJ Occlusion of Thoracic Aorta with Intraluminal Device, Temporary, Percutaneous Approach

Below is a chart showing the typical MS-DRGs and respective hospital reimbursement rates, assuming the occlusive balloon is the only procedure.  Depending on the patient’s diagnosis and whether or not the patient receives a subsequent surgical correction, the DRG assignment may be different.

MS-DRG MS-DRG Description** FY 2019 National Average Hospital Reimbursement for Inpatient Procedures*
907 Other O.R. procedures for injuries w MCC $25,800
908 Other O.R. procedures for injuries w CC $12,200
909 Other O.R. procedures for injuries w/o CC/ MCC $8,100

Note:  These are national averages and do not include hospital-specific adjustments for location, teaching status or charity care.

** MCC = Major complication or co-morbidity
CC=Complication or co-morbidity

CPT Procedure Code

Current Procedural Terminology (CPT-4) Codes are uniformly accepted by all payers and may be used to describe services rendered by the physician or hospital outpatient department.  The following code may be appropriate to describe REBOA procedures.

37244 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation

CPT Code CPT Code Description CY 2019 National Average Physician Professional Fee*
37244 Vascular Embolization and Occlusion $696

*Does not include geographic adjustment.

CPT codes and nomenclature are Copyright 2018 American Medical Association

Disclaimer –We strongly suggest that you consult your payer organization with regard to local reimbursement policies.  The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Prytime Medical, Inc. concerning levels of reimbursement, payment or charge.  Similarly, all ICD-10 and CPT codes are supplied for information purposes only and represent no statement; promise or guarantee by Prytime Medical, Inc. that these codes will be appropriate or that reimbursement will be made.