MAC Implementation File 8 - New Technology Add-on Payment (NTAP) - Technologies NO LONGER Receiving NTAP in FY 2025			
Technology	Maximum Add-on Payment in FY 2024	ICD-10-CM/PCS Coding Used to Identify Cases Eligible for NTAP	Alternative Pathways Status
Intercept Fibrinogen Complex (PRCFC)	"$2,535.00"	"30233D1 or 30243D1in combination with one of the following:D62, D65, D68.2, D68.4, or D68.9"	Breakthrough Device
Rybrevant (amivantamab)	"$6,405.89"	XW033B7 or XW043B7	
StrataGraft	"$44,200.00"	XHRPXF7	
aprevo Intervertebral Body Fusion Device (TLIF indication)	"$40,950.00"	"XRGA0R7, XRGA3R7, XRGA4R7, XRGB0R7, XRGB3R7, XRGB4R7, XRGC0R7, XRGC3R7, XRGC4R7, XRGD0R7, XRGD3R7, or XRGD4R7"	Breakthrough Device
Hemolung Respiratory Assist System (RAS) (non-COVID-19 related use)	"$6,500.00"	5A0920Z without U07.1	
Livtencity (maribavir) 	"$32,500.00"	XW0DX38 or XW0G738 or XW0H738	
Canary Tibial Extension (CTE) with Canary Health Implanted Reporting Processor (CHIRP) System*	$850.85	XNHG0F9	Breakthrough Device
	$850.85	XNHH0F9	Breakthrough Device
			
