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Correction: ECMO/ECLS Services Code Conversion and Policy Updates

May 2, 2017

The following article corrects code references under the “Code Conversion” heading of an article published in the February 2016 Medi-Cal Update. The corrected article follows in its entirety.

Effective retroactively for dates of service on or after January 1, 2015, multiple ECMO/ECLS services are added as Medi-Cal benefits. ECMO (Extracorporeal Membrane Oxygenation) is defined as the use of a modified cardiopulmonary bypass circuit for temporary life support for patients with potentially reversible cardiac and/or respiratory failure, also known as Extra Corporeal Life Support (ECLS). ECMO/ECLS provides a mechanism for gas exchange and cardiac support allowing for recovery from existing lung and/or cardiac disease. ECMO/ECLS is an accepted treatment modality for newborns with respiratory and/or cardiac failure unresponsive to conventional medical therapy.

Indications and Selection Criteria
ECMO/ECLS is indicated for but not limited to the following diagnoses:

  • Persistent pulmonary hypertension of the newborn
  • Meconium aspiration syndrome
  • Respiratory distress syndrome
  • Sepsis/pneumonia
  • Congenital diaphragmatic hernia
  • Air leak syndrome
Selection criteria include all of the following:
  • Gestational age not less than 34 weeks
  • Minimum birth weight of 2,000 grams
  • No coagulopathy or uncontrolled bleeding
  • No intracranial hemorrhage
  • Mechanical ventilation less than 14 days
  • Reversible lung disease
  • No lethal congenital anomalies
  • No uncorrectable congenital heart disease
  • No irreversible brain damage
  • Failure of maximal medical or conventional therapy

TAR/SAR Requirement
An approved Treatment Authorization Request (TAR) or Service Authorization Request (SAR) is required for reimbursement of CPT-4 codes 33946 and 33947 only. All other ECMO/ECLS services do not require an approved TAR or SAR.

Physician Services
Neonatology services directly related to the cannulation, initiation, management and discontinuation of the ECMO/ECLS circuit and parameters are distinct from the daily overall management of the patient.

Daily overall management of the patient may be separately reported using the relevant hospital inpatient services, or critical care evaluation and management CPT-4 codes, and may be reimbursed to any provider, same recipient and same date of service. Reference the 2015 Current Procedural Terminology – 4th Edition code book for detailed physician billing instructions for the ECMO/ECLS services for each code.

Inpatient Services
ECMO/ECLS must be performed in a neonatal intensive care unit approved by the California Children’s Services as both a Regional Neonatal Intensive Care Unit (NICU) and an ECMO center.

Code Conversion
The CPT-4 codes listed in the table below represent ECMO/ECLS services and replace CPT-4 codes 33960 (prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24 hours), 33961 (each additional 24 hours) and existing code 36822 (insertion of cannula(s) for prolonged ECMO). Assistant surgeon services are not reimbursable for these CPT-4 codes.

CPT-4 Code Description
33946* Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous
33947* initiation, veno-arterial
33948* daily management, each day, veno-venous
33949* daily management, each day, veno-arterial
33951 insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)
33953 insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age
33955 insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age
33957 reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)
33959 reposition peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age (includes fluoroscopic guidance, when performed)
33963 reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)
33965 removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age
33969 removal of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age
33985 removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age
33987 Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS
33988 Insertion of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS
33989 Removal of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS

*CPT-4 codes 33946 – 33949 are not reimbursable when billed with modifier 63.