MAC Implementation File 8 - FY 2022 New Technology Add-on Payment (NTAP) - Technologies Beginning to Receive NTAP 			
Technology	Maximum Add-on Payment	ICD-10-CM/PCS Codes Used to Identify Cases Eligible for NTAP	Alternative Pathways Status
ascope duodeno	"$1,715.58"	XFJB8A7 or XFJD8A7	Breakthrough
aprevo	"$40,950.00"	"XRGA0R7, XRGA3R7, XRGA4R7, XRGB0R7, XRGB3R7, XRGB4R7, XRGC0R7, XRGC3R7, XRGC4R7, XRGD0R7, XRGD3R7, or XRGD4R7 "	Breakthrough
Caption Guidance	"$1,868.10"	X2JAX47	Breakthrough
Exalt Model D	"$1,715.58"	XFJB8A7 or XFJD8A7	Breakthrough
Cefiderocol (Fetroja)	"$8,579.84"	"XW033A6 or XW043A6 in combination with Y95 and one of the following: J14, J15.0, J15.1, J15.5, J15.6, J15.8 OR XW033A6 or XW043A6 in combination with 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
HARMONY TPV	"$26,975.00"	02RH38M	Breakthrough
PRCFC	"$2,535.00"	"30233D1 or 30243D1 in combination with D62, D65, D68.2, D68.4, or D68.9"	Breakthrough
RECARBRIO	"$9,576.51"	"XW033U5 or XW043U5 in combination with Y95 and one of the following: J14, J15.0, J15.1, J15.5, J15.6, or J15.8 OR XW033U5 or XW043U5 in combination with 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
Amivantamab (Rybrevant)	"$6,405.89"	XW033B7 or XW043B7	
Idecabtagene vicleucel (Abecma)	"$272,675.00"	XW033K7 or XW043K7	
StrataGraft	"$44,200.00"	XHRPXF7	
Tecartus	"$259,350.00"	XW033M7 or XW043M7	
Trilaciclib	"$5,526.30"	XW03377 or XW04377	
Veklury	"$2,028.00"	XW033E5 or XW043E5	
Zepzelca	"$8,622.90"	XW03387 or XW04387	
