MKT 123 R1 aprevoCervicalCodingCard 161025 Web.pdf
aprevo cervical
What Hospitals Need to Know:
The FDA designated aprevo® Cervical devices as a Breakthrough technology.
Effective October 1, 2025, the aprevo® Cervical interbody device is eligible for an incremental New Technology Add-on Payment (NTAP) for Traditional Medicare patients. For each qualifying inpatient procedure, CMS calculates the NTAP amount by taking 65% of the difference between the hospital’s MS-DRG payment and the estimated cost of the procedure (calculated from the hospital’s charges included on the case’s UB-04 form and hospital-specific CCR) up to the maximum NTAP cap of $21,125.
ICD-10-PCS Codes for aprevo® Cervical Custom-Made Anatomically Designed Interbody Fusion Devices (CMADIFD)
Cases using the aprevo® Custom-Made Anatomically Designed Interbody Fusion Devices will be assigned to MS-DRGs based on ICD-10-PCS and ICD-10-CM codes.
Update charge masters to appropriately account for acquisition costs.
Commercial payer reimbursement varies by contract.
ICD-10-PCS Codes
| ICD-10-PCS CODE | DESCRIPTION |
|---|---|
| XRG10RB | Fusion of cervical vertebral joint using CMADIFD, open approach, new technology group 11 |
| XRG13RB | Fusion of cervical vertebral joint using CMADIFD, percutaneous approach, new technology group 11 |
| XRG14RB | Fusion of cervical vertebral joint using CMADIFD, percutaneous endoscopic approach, new technology group 11 |
| XRG20RB | Fusion of 2 or more cervical vertebral joints using CMADIFD, open approach, new technology group 11 |
| XRG23RB | Fusion of 2 or more cervical vertebral joints using CMADIFD, percutaneous approach, new technology group 11 |
| XRG24RB | Fusion of 2 or more cervical vertebral joints using CMADIFD, percutaneous endoscopic approach, new technology group 11 |
| XRG40RB | Fusion of cervicothoracic vertebral joint using CMADIFD, open approach, new technology group 11 |
| XRG43RB | Fusion of cervicothoracic vertebral joint using CMADIFD, percutaneous approach, new technology group 11 |
| XRG44RB | Fusion of cervicothoracic vertebral joint using CMADIFD, percutaneous endoscopic approach, new technology group 11 |
Hospital Coding Tips:
Specific ICD-10-PCS codes have been created to describe the procedures using the aprevo® Custom-Made Anatomically Designed Interbody Fusion Device (see list).
Hospitals have the ability to set charges for items properly so that charges converted to costs can appropriately account fully for their acquisition and overhead costs.
The Centers for Medicare & Medicaid Services (CMS) stated, ”there is nothing that precludes hospitals from setting their charges consistent with their CCRs.”
Hospitals may consider the cost of the aprevo® Custom-Made Anatomically Designed Interbody Fusion Devices to their facility when setting charges for procedures using aprevo® devices.
Applicable Cervical MS-DRGs May Include:
| MS-DRG CODE | DESCRIPTION |
|---|---|
| MS-DRG 429 | Combined Anterior and Posterior Cervical Spinal Fusion with MCC |
| MS-DRG 430 | Combined Anterior and Posterior Cervical Spinal Fusion without MCC |
| MS-DRG 471 | Cervical Spinal Fusion with MCC |
| MS-DRG 472 | Cervical Spinal Fusion with CC |
| MS-DRG 473 | Cervical Spinal Fusion without CC/MCC |
Disclaimer
It is the responsibility of the provider to determine and report appropriate codes, modifiers, and charges for healthcare services rendered to patients in their care. This document is made available to U.S. customers and prospective customers of Carlsmed, Inc. Similarly, all codes are referenced herein for informational purposes only and represent no statement, promise or guarantee by Carlsmed® that these code selections are appropriate for any given prospective service, or that reimbursement will be made to the provider reporting these services. Carlsmed® strongly recommends consulting your respective contracted payor organizations regarding its coding and coverage medical policies.
For Coding Questions, Contact the aprevo® Coding Hotline
866-aprevo1 (866-277-3861) | aprevocoding@jdlaccess.com