The TriNav® Infusion System is eligible for Medicare TPT reimbursement throughout 2023.

The CMS Transitional Pass-Through Payment (TPT) program facilitates Medicare patient access to new and innovative technologies.

The Centers for Medicare & Medicaid Services (CMS) TPT program facilitates Medicare patient access to new and innovative device technologies that have shown substantial clinical improvement over standard of care.

This important program allows for adequate payment of innovative products while CMS collects the data necessary to incorporate the cost of these technologies into permanent ambulatory payment classification (APC) outpatient payment rates.

As of January 1, 2020, the TriNav Infusion System is approved for TPT reimbursement.

After review of the TriNav application, supporting clinical data and favorable comments from the stakeholders, CMS determined that TriNav met the narrow program eligibility criteria, including demonstration of substantial clinical improvement compared to existing devices.1

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Procedure Codes

To describe the use of TriNav, CMS created HCPCS Code C19821 (catheter, pressure-generating, one-way valve, intermittently occlusive). Pass-through codes should be used in conjunction with the procedure code(s) currently used by hospitals.

Medicare has stated that the device code describing TriNav should
always be billed with CPT Code 372422,3 or CPT Code 37243.2,3

37242 – Mapping (vascular embolization or occlusion, artery)

37243 – Treatment (vascular embolization or occlusion, organ)

CMS will make TPT payment when either code is appropriately reported in association with TriNav and TPT HCPCS Code C1982.3

Download Coding Information

Reimbursement Support

For more information, contact TriNav Reimbursement Support at reimbursement@TriSalusLifeSci.com.

  • Physician and hospital coding assistance
  • Educational overview of Transitional Pass-Through Payment methodology
  • Determine hospital-specific Transitional Pass-Through Payment calculation for Medicare
  • Provide information to general reimbursement questions specific to TriNav commercial coverage
  • Proactive onboarding program to walk through TPT coding process

While most payers usually follow suit with Medicare Part B coverage policy, the reimbursement methodologies and amounts may vary. Facilities are encouraged to contact payers prior to using a product on TPT status to confirm coverage and reimbursement policies.

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The coding information provided is general in nature, gathered from third-party sources and subject to change without notice. The provider is solely responsible for determining medical necessity, the appropriate setting for service delivery, and submitting accurate claims for products and services rendered. TriSalus encourages facilities to contact payers for specific information on their coding, coverage and payment policies.

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Rx Only. For the safe and proper use of the TriNav device, refer to the Instructions for Use.

Indications for Use: The TriNav Infusion System is intended for use in angiographic procedures. It delivers radiopaque media and therapeutic agents to selected sites in the peripheral vascular system.4

Contraindications: TriNav is not intended for use in the vasculature of the central nervous system (including the neurovasculature) or central circulatory system (including the coronary vasculature).4

References

1. Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payments Systems Final Rule, 84 Fed.Reg. 218, 61142, 61274-76 (Nov. 12, 2019) (2020 OPPS Final Rule). 2. January 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.0, Medicare Claims Processing Manual, Transmittal 10540 (Dec. 31, 2020). 3. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payments Systems Final Rule, 85 Fed.Reg. 249, 85866, 85987-88 (Dec. 29, 2020) (2021 OPPS Final Rule). 4. TriSalus™ TriNav® Infusion System, Instructions for Use.