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Additional Reimbursement Options for Qualifying RapidAI Products

Under the Inpatient Prospective Payment System (IPPS), Medicare pays for a patient’s inpatient hospital stay with one bundled payment. While drugs, devices and supplies typically fall under this single payment, some technologies do not. Fortunately for hospitals, additional reimbursement options exist for certain RapidAI products.

NTAP

The New Technology Add-on Payment (NTAP) is an additional Medicare reimbursement that financially assists healthcare organizations when they adopt new technology. For a new technology to qualify for the NTAP program, it must meet eligibility requirements established by the Centers for Medicare & Medicaid Services (CMS).

CMSgov

Qualifying RapidAI Products

RapidLVA

Rapid LVO

CMS approved an NTAP for radiological computer-assisted triage and notification software that analyzes CTA images of the brain and notifies hospital staff when a suspected large vessel occlusion (LVO) is identified. As a product utilizing this approved technology, Rapid LVO explicitly meets NTAP requirements and is covered by the FY2021 IPPS Rule.

Coding for Rapid LVO

When Rapid LVO software is utilized — and medical records support the use of the technology* — hospitals should report the appropriate codes on the claim to be eligible for an NTAP reimbursement.

ICD-10-PCS**

ICD-10-PCS Code
Description
4A03X5D
Measurement and Monitoring (4), Physiological Systems (A), Measurement (0), Arterial (3), External (X), Flow (5), Intracranial (D)
ICD-10-PCS Code
4A03X5D
Description
Measurement and Monitoring (4), Physiological Systems (A), Measurement (0), Arterial (3), External (X), Flow (5), Intracranial (D)

Procedure Code

CPT Code
Description
70496
Computed tomographic angiography, head, with contrast material(s), including non-contrast images, if performed, and image postprocessing
CPT Code
70496
Description
Computed tomographic angiography, head, with contrast material(s), including non-contrast images, if performed, and image postprocessing

* Medical records must include documentation that supports the services rendered and the technology used.

** These codes are derived from the ICD-10-PCS Code Set. Please refer to the official ICD-10-PCS Code Set for complete tables and coding instruction.

Understanding NTAP: A Guide to Medicare Reimbursement for Rapid LVO

Reimbursement Resources

How Medicare Reimburses

Medicare reimburses acute care hospital inpatient stays based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. 

Download DRG Codes:

Ischemic Stroke

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Documentation and Coding for New Technology Add-On Payments

Need Assistance?

We offer a wide range of reimbursement support, including coding and billing assistance and appeal process research and support.

Hospitals should review their local payer’s guidelines regarding appropriate documentation, medical necessity and coding information.