Payment for Extracorporeal Shock Wave Lithotripsy (ESWL)

A ninth ASC payment group was established in a Federal Register notice (56 FR 67666) published December 31, 1991. The ninth payment group amount ($1,150) was assigned to only one procedure, CPT code 50590©, fragmenting of kidney stone. However, a court order issued March 12, 1992, has stayed the Group 9 payment rate until the Secretary publishes all information relevant to the setting of the ESWL rate, receives comments and publishes a subsequent final notice. This has not yet been completed.

In a previous instruction (Medicare Carrier’s Manual Transmittal 1435), CMS advised contractors to make payment to ASCs for ESWL services furnished after January 29, 1992, and through the date when the ASC received notice from the contractors of the court order staying the Group 9 payment rate. This was a temporary measure to avoid penalizing ASCs that furnished ESWL services in accordance with the December 31, 1991, Federal Register notice and that could not have been expected to know that the March 12, 1992, court order set aside the ESWL provisions of that notice. Contractors did not make Medicare payment for ESWL as an ASC procedure when such services were furnished after the date the contractors advised an ASC of the court order.

Medicare contractors were instructed to retain all ASC claims for ESWL with a service date after January 29, 1992, and before the date when they were notified about the court order. It may be necessary to retrieve these claims for further action at some later date.

Beginning January 1, 2008, with the revised ASC payment system, Medicare will pay for any of the ESWL services that are included on the ASC list of covered surgical procedures.
• 50590© Fragmenting of kidney stone