What is Shockwave IVL?

Shockwave IVL utilizes acoustic pressure waves to modify arterial calcium to maximize luminal gain and stent expansion. Its unique mechanism of action leverages the principles of Extracorporeal Shockwave Lithotripsy (ESWL) with modifications to optimize safety and effectiveness within the arterial vasculature.

Since its launch in early 2021, Shockwave Coronary IVL has been rapidly adopted by the Interventional Cardiology community and is the most frequently used calcium modification strategy for treatment of calcified coronary lesions¹. Additionally, Shockwave Medical has pioneered within the Percutaneous Coronary Intervention (PCI) reimbursement space with robust reimbursement pathways that cover the incremental cost and remunerates physicians when Coronary IVL is utilized.

Please find more information on Shockwave IVL's mechanism of action and available reimbursement pathways for Shockwave Coronary IVL below.

1: Butala, N. Use of Calcium Modification for Coronary Lesions after Introduction of Coronary Intravascular Lithotripsy: National Trends and Hospital Variation. SCAI 2023. 

Coronary IVL Hospital Inpatient Reimbursement

The FY2025 Medicare Base Payment Rates for inpatient Coronary IVL and standard PCI procedures described in the below table are effective starting October 1, 2024. As compared to the prior year, the payments associated with Coronary IVL MS-DRGs have increased by ~$2,000 and the incremental payment between standard PCI and Coronary IVL with stent procedures has increased to ~$10,000. Hospital-specific rates will vary.

1: MCC: Major Complications and Comorbidities; CC: Complications and Comorbidities.
2: CMS-1808-IFC; National Average MS-DRG rates shown are based on Medicare Inpatient Prospective Payment System FY2025 Final Rule, Table 1 & Table 5. National average payment rates assume full update amount for hospitals which have submitted quality data and hospitals have a wage index greater than 1. Site specific payment rates will vary based on regional area wage differences, teaching hospital status, indirect medical education costs, quality data, additional payments to hospitals that treat a large percentage of low-income patients (“disproportionate share payments”), etc. MS-DRG payment rates shown do not include sequestration reduction.

Coronary IVL Physician Reimbursement

In Calendar Year (CY) 2024, The Centers for Medicare & Medicaid Services (CMS) established relative value units (RVUs) and associated physician payment for Current Procedural Terminology (CPT®)1 +92972, a Category I Add-on code for designated primary procedures involving Coronary IVL. For CY 2025, CPT® +92972 will continue to provide an additional 2.97 work RVUs and $139 payment in addition to the primary procedure effective January 1, 2025.

CPT® code +92972 is an add-on code that must be used in conjunction with a designated primary procedure procedure CPT® code. The payment rate for +92972 is in addition to physician payment for the primary procedure CPT® code and can be used in addition to adjunctive technologies (i.e. atherectomy, PTCA) are performed in conjunction with Coronary IVL. Please see the below tables for more information.

CPT® is a registered trademark of the American Medical Association. Copyright 1995-2024. All rights reserved.
1: CMS-1807-F; Medicare Physician Fee Schedule, MPFS, Calendar Year 2025 Final Rule. 11/01/24, Addendum B, using conversion factor 32.3465.
2: Payment rates do not take into account geographical or additional adjustments. Providers should contact their local Medicare Administrative Contractor (MAC) or CMS for specific information as payment rates vary by region.

Reimbursement Disclaimer (US):
The coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. Shockwave Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies.

Indications for Use— The Shockwave Intravascular Lithotripsy (IVL) System with the Shockwave C²⁺ Coronary IVL Catheter is indicated for lithotripsy enabled, low-pressure balloon dilatation of severely calcified, stenotic de novo coronary arteries prior to stenting.

Contraindications—The Shockwave C²⁺ Coronary IVL System is contraindicated for the following: This device is not intended for stent delivery. This device is not intended for use in carotid or cerebrovascular arteries.

Warnings—Use the IVL Generator in accordance with recommended settings as stated in the Operator’s Manual. The risk of a dissection or perforation is increased in severely calcified lesions undergoing percutaneous treatment, including IVL. Appropriate provisional interventions should be readily available. Balloon loss of pressure was associated with a numerical increase in dissection which was not statistically significant and was not associated with MACE. Analysis indicates calcium length is a predictor of dissection and balloon loss of pressure. IVL generates mechanical pulses which may cause atrial or ventricular capture in bradycardic patients. In patients with implantable pacemakers and defibrillators, the asynchronous capture may interact with the sensing capabilities. Monitoring of the electrocardiographic rhythm and continuous arterial pressure during IVL treatment is required. In the event of clinically significant hemodynamic effects, temporarily cease delivery of IVL therapy.

Precautions— Only to be used by physicians trained in angiography and intravascular coronary procedures. Use only the recommended balloon inflation medium. Hydrophilic coating to be wet only with normal saline or water and care must be taken with sharp objects to avoid damage to the hydrophilic coating. Appropriate anticoagulant therapy should be administered by the physician. Precaution should be taken when treating patients with previous stenting within 5mm of target lesion.

Potential adverse effects consistent with standard based cardiac interventions include– Abrupt vessel closure - Allergic reaction to contrast medium, anticoagulant and/or antithrombotic therapy Aneurysm-Arrhythmia-Arteriovenous fistula-Bleeding complications-Cardiac tamponade or pericardial effusion Cardiopulmonary arrest-Cerebrovascular accident (CVA)- Coronary artery/vessel occlusion, perforation, rupture or dissection-Coronary artery spasm-Death-Emboli (air, tissue, thrombus or atherosclerotic emboli)-Emergency or nonemergency coronary artery bypass surgery-Emergency or nonemergency percutaneous coronary intervention-Entry site complications-Fracture of the guide wire or failure/malfunction of any component of the device that may or may not lead to device embolism, dissection, serious injury or surgical intervention Hematoma at the vascular access site(s)-HemorrhageHypertension/Hypotension-Infection/sepsis/fever-Myocardial Infarction-Myocardial Ischemia or unstable angina-Pain Peripheral Ischemia-Pseudoaneurysm-Renal failure/insufficiency-Restenosis of the treated coronary artery leading to revascularization-Shock/pulmonary edema-Slow flow, no reflow, or abrupt closure of coronary artery-Stroke-Thrombus Vessel closure, abrupt-Vessel injury requiring surgical repair Vessel dissection, perforation, rupture, or spasm.

Risks identified as related to the device(s) and its use: Allergic/immunologic reaction to the catheter material(s) or coating-Device malfunction, failure, or balloon loss of pressure leading to device embolism, dissection, serious injury or surgical intervention-Atrial or ventricular extrasystole-Atrial or ventricular capture.

Prior to use, please reference the Instructions for Use for more information on indications, contraindications, warnings, precautions and adverse events. www.shockwavemedical.com/IFU

The coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. Shockwave Medical cannot guarantee success in obtaining third-party insurance payments. Third-party payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies.

© 2025 Shockwave Medical Inc. All rights reserved. SPL - 72611 Rev. B. Sponsored by Shockwave Medical.