MAC Implementation File 8 - FY 2023 New Technology Add-on Payment (NTAP) - Technologies Continuing to Receive NTAP 			
Technology	Maximum Add-on Payment	ICD-10-CM/PCS Coding Used to Identify Cases Eligible for NTAP	Alternative Pathways Status
aScope duodeno	"$1,296.75"	XFJB8A7 or XFJD8A7	Breakthrough Device
aprevo	"$40,950.00"	"XRGA0R7, XRGA3R7, XRGA4R7, XRGB0R7, XRGB3R7, XRGB4R7, XRGC0R7, XRGC3R7, XRGC4R7, XRGD0R7, XRGD3R7, or XRGD4R7"	Breakthrough Device
Caption Guidance	"$1,868.10"	X2JAX47	Breakthrough Device
Fetroja (cefiderocol) (HABP/VABP)	"$8,579.84"	"XW033A6 or XW043A6in combination withY95 and one of the following: J14, J15.0, J15.1, J15.5, J15.6, J15.8ORXW033A6 or XW043A6in combination withJ95.851 and one of the following: B96.1, B96.20, B96.21, B96.22, B96.23, B96.29, B96.3, B96.5, B96.89"	QIDP
HARMONY TPV 	"$26,975.00"	02RH38M	Breakthrough Device
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
RECARBRIO (HABP/VABP)	"$9,576.51"	"XW033U5 or XW043U5in combination withY95 and one of the following: J14, J15.0, J15.1, J15.5, J15.6, or J15.8ORXW033U5 or XW043U5in combinationwith J95.851 and one of the following: B96.1, B96.20, B96.21, B96.22, B96.23, B96.29, B96.3, B96.5, B96.89"	QIDP
Shockwave Coronary IVL	"$3,666.00"	02F03ZZ or 02F13ZZ or 02F23ZZ or 02F33ZZ	Breakthrough Device
Rybrevant (amivantamab)	"$6,405.89"	XW033B7 or XW043B7	
Abecma (idecabtagene vicleucel)	"$289,532.75"	XW033K7 or XW043K7	
StrataGraft	"$44,200.00"	XHRPXF7	
Tecartus (brexucabtagene autoleucel)	"$259,350.00"	XW033M7 or XW043M7	
Cosela(trilaciclib)	"$5,612.10"	XW03377 or XW04377	
Veklury (remdesivir)	"$2,028.00"	XW033E5 or XW043E5	
Zepzelca (lurbinectedin)	"$9,145.50"	XW03387 or XW04387	
