MAC Implementation File 8 - FY 2025 New Technology Add-on Payment (NTAP) - Technologies Beginning to Receive NTAP in FY 2025				
Technology	Maximum Add-on Payment	ICD-10-CM/PCS Codes Used to Identify Cases Eligible for NTAP	Alternative Pathways Status	
Annalise Enterprise CTB Triage - OH	$241.39	XXE0X1A 	Breakthrough Device	
ASTar System 	$97.50	XXE5X2A 	Breakthrough Device	
Edwards EVOQUE Tricuspid Valve Replacement System	"$31,850.00"	X2RJ3RA 	Breakthrough Device	
GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE Device)	"$47,238.75"	X2VE3SA 	Breakthrough Device	
LimFlow System	"$16,250.00"	"041M3JS, 041N3JS, 041P3JS, 041Q3JS, 041R3JS, 041S3JS, 041T3JS, or 041U3JS"	Breakthrough Device	
Paradise Ultrasound Renal Denervation System	"$14,950.00"	X051329 	Breakthrough Device	
PulseSelect Pulsed Field Ablation (PFA) Loop Catheter	"$6,337.50"	02583ZF 	Breakthrough Device	
Symplicity Spyral Multi-Electrode Renal Denervation Catheter	"$10,400.00"	X05133A 	Breakthrough Device	
TriClip G4	"$26,000.00"	02UJ3JZ 	Breakthrough Device	
VADER Pedicle System	"$28,242.50"	"XRH60FA, XRH63FA, XRH64FA, XRH70FA, XRH73FA, XRH74FA, XRH80FA, XRH83FA, XRH84FA, XRHA0FA, XRHA3FA, XRHA4FA, XRHB0FA, XRHB3FA, XRHB4FA, XRHC0FA, XRHC3FA, XRHC4FA, XRHD0FA, XRHD3FA, or XRHD4FA in combination with one of the following: M46.20, M46.22, M46.23, M46.24, M46.25, M46.26, M46.27, M46.30, M46.32, M46.33, M46.34, M46.35, M46.36, M46.37, M46.39, M46.40, M46.42, M46.43, M46.44, M46.45, M46.46, M46.47, M46.49, M46.50, M46.51, M46.52, M46.53, M46.54, M46.55, M46.56, M46.57, M46.59, M46.80, M46.82, M46.83, M46.84, M46.85, M46.86, M46.87, M46.89, M46.90, M46.92, M46.93, M46.94, M46.95, M46.96, M46.97, or M46.99"	Breakthrough Device	
ZEVTERA (ceftobiprole medocaril); ABSSSI and CABP indications	"$2,812.50"	XW0335A or XW0435A 	QIDP	
ZEVTERA (ceftobiprole medocaril); SAB indication	"$8,625.00"	XW0335A or XW0435A in combination with R78.81 (in combination with B95.61 or B95.62)	QIDP	
CASGEVY (exagamglogene autotemcel); Sickle Cell Disease indication	"$1,650,000.00"	"XW133J8 or XW143J8 in combination with one of the following: D57.1, D57.20, D57.40, D57.42, D57.44, or D57.80"		
ELREXFIO (elranatamab-bcmm) and TALVEY (talquetamab-tgvs)*	"$12,899.59"	XW013L9 or XW01329		
HEPZATO KIT (melphalan for injection/hepatic delivery system)	"$118,625.00"	XW053T9 in combination with 5A1C00Z		
LYFGENIA (lovotibeglogene autotemcel))	"$2,325,000.00"	XW133H9 or XW143H9 		
				
*These two technologies were determined to be substantially similar to each other and were therefore evaluated as one application for new technology add-on payments under the IPPS.				
				
				
				
				
