Esprit BTK Case Economics

v4 · All reimbursement values from Cagent VAC packet (2026 rates) + Abbott NTAP/TPT resources

NTAP max $6,922.50 TPT via C1743 — HOPD / ASC only Serranator HCPCS: C1725

Site of service

Lesion type

Devices

Serranator balloonsHCPCS C1725

Serranator unit costCagent ASP

Esprit BTK scaffoldsHCPCS C1743 · 0 = PTA only

Esprit unit costPer scaffold (hospital acquisition)

TPT calculation

Pass-through payment $0

Scenario comparison Hospital outpatient

PTA only37280

Facility payment$11,794

Physician payment$448

Device cost−$1,200

Hospital margin$10,594

+ Esprit BTK37284

Facility payment$18,729

Physician payment$461

TPT pass-through$8,000

Device cost−$9,200

Hospital margin$17,529

Hospital Δ +$6,935

Physician Δ +$13

Device cost Δ −$8,000

Economic verdict

Loading analysis...

Show full CPT reference table (BTK 2026)

Code	Procedure	HOPD	ASC	OBL	Phys
37280	PTA, straightforward, initial	$11,794	$7,078	$2,699	$448
37282	PTA, complex, initial	$11,794	$7,078	$6,103	$561
37284	Stent+PTA, straightforward	$18,729	$12,207	$5,635	$461
37286	Stent+PTA, complex	$18,729	$12,207	$10,375	$619
37288	Atherectomy+PTA, straightforward	$18,729	$12,373	$7,802	$609
37290	Atherectomy+PTA, complex	$18,729	$12,373	$10,655	$767
37292	Atherectomy+Stent+PTA, sf	$18,729	$12,901	$10,240	$679
37294	Atherectomy+Stent+PTA, cx	$18,729	$12,901	$15,211	$814
C9772	IVL tibial/peroneal	$11,794	$8,000	—	—
C9773	IVL + stent tib/per	$18,729	$12,025	—	—
C9774	IVL + atherectomy tib/per	$18,729	$13,604	—	—
C9775	IVL + stent + atherectomy	$18,729	$14,121	—	—

Source: Cagent VAC packet MKT-0011 Rev L · 2026 Medicare Physician Fee Schedule (National Average)

Show formula reference (NTAP + TPT math)

NTAP (inpatient only, per Abbott MAT-2509544):
NTAP = min( 0.65 × max(0, case_cost − DRG) , $6,922.50 )
The $6,922.50 is CMS's pre-computed 65% of approved tech cost. Device count does not change the formula. Paid once per discharge; $0 if case cost ≤ DRG.

TPT (outpatient + ASC only, per Abbott MAT-2602731):
TPT = (hospital charge × device CCR) − device offset
For Esprit BTK, offset = $0. Approximated as scaffold count × ASP. Effective Apr 1, 2026 through Mar 31, 2029.

CPT selection: Serranator alone → 37280 (sf) / 37282 (cx). Serranator + Esprit scaffold → 37284 (sf) / 37286 (cx).

OBL pricing note: Office-based lab rates include both facility and professional fees in a single MPFS payment — physician-owner captures full margin. TPT does NOT apply to OBL (it's an OPPS mechanism, and OBLs are paid under the Physician Fee Schedule). The bundled OBL rate must absorb any scaffold cost.

Built for Cagent internal planning · Not for external distribution
Sources: Cagent VAC Packet (MKT-0011 Rev L), Abbott NTAP Resource (MAT-2509544 v1.0), TPT Resource (MAT-2602731 v1.0)
CMS: CMS-1833-F (FY2026 IPPS), CMS-1834-FC (CY2026 OPPS/ASC), CMS-1832-F (CY2026 MPFS), R13686CP TPT