Medicare Part B Payments for Lower Extremity Peripheral Vascular Procedures

OBJECTIVE

The use of peripheral vascular procedures in an office setting has increased among the Medicare population over the past decade. For CYs 2022 and 2023, Medicare paid approximately $1.16 billion for lower extremity peripheral vascular procedures in office settings. These minimally invasive procedures aim to improve blood flow when arteries narrow or become blocked because of peripheral arterial disease but are generally recommended only after patients have tried medical and exercise therapy and have lifestyle-limiting symptoms. In addition, CMS and whistleblower fraud investigations have identified these procedures as vulnerable to improper payments. We will analyze Medicare fee-for-service for peripheral vascular procedures for questionable characteristics and review the program integrity activities of CMS and its contractors to combat fraud, waste, and abuse specific to these procedures. Additionally, we will assess whether these procedures complied with CMS requirements and met applicable treatment guidelines.

TIMELINE

• June 17, 2024
  Announced
• Today
  Office of Audit Services In-Progress
• Est FY2026
  Estimated Fiscal Year for Project Completion

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