ACES™ reimbursement & coding
ACES fits smoothly into current reimbursement frameworks, reducing barriers to adoption. With established coding and payment available across inpatient, outpatient, and physician billing, practices can confidently implement ACES with predictable reimbursement pathways.
Coding and payment across inpatient and outpatient settings
Inpatient Setting
Existing DRGs for pleural effusions and established ICD-10-PCS codes for pleural-to-peritoneal bypass procedures can be used to bill for ACES
Outpatient Setting
ACES can be billed using a combination of existing CPT codes that cover peritoneal catheter placement and pleural drainage procedures
Physician Payment (Inpatient & Outpatient)
The same set of existing CPT codes used for peritoneal catheter and pleural drainage procedures are applicable for physician reimbursement when performing ACES
Find the right codes for your practice
With established codes available across inpatient, outpatient, and physician billing, practices have full visibility into ACES reimbursement requirements. This allows teams to implement ACES confidently with predictable payment pathways.
Download the ACES coding and reimbursement guide
This guide provides key reimbursement information to support accurate claims submission. Because traditional Medicare policies often shape other payor policies, Medicare coding, coverage, and payment guidelines are referenced throughout unless noted otherwise.
Hospital inpatient setting
Inpatient Procedure Codes ICD-10 PCS Codes (examples only)
Coding should be based on documentation in the patient’s medical record. Depending on procedure(s) performed, multiple codes may be reported. For a list of all possible ICD-10 procedure codes, refer to the ICD-10-PCS 2026 Codebook.
| Code | Description |
|---|---|
| J90 | Pleural effusion, not elsewhere classified |
| 0W190JG | Bypass Right Pleural Cavity to Peritoneal Cavity with Synthetic Substitute, Open Approach |
| 0W1B0JG | Bypass Left Pleural Cavity to Peritoneal Cavity with Synthetic Substitute, Open Approach |
| 0W193JG | Bypass Right Pleural Cavity to Peritoneal Cavity with Synthetic Substitute, Perc Approach |
| 0W1B3JG | Bypass Left Pleural Cavity to Peritoneal Cavity with Synthetic Substitute, Perc Approach |
Medicare 2026 Hospital Inpatient Payment
Hospitals are reimbursed by Medicare for inpatient procedures and services under the FY2026 Inpatient Prospective Payment System (IPPS), which utilizes the Medicare Severity Diagnosis Related Group (MS-DRG) system. Each MS-DRG payment amount includes the cost of all devices. The following are typical MS-DRGs assigned based on procedure and diagnoses. Assignment will vary based on diagnosis(es) and procedure(s) performed.
| MS-DRG | Description | FY2026 MS-DRG Base Rate1 |
|---|---|---|
| ACES System when the Primary Diagnosis is Malignant Pleural Effusion | ||
| 180 | Respiratory Neoplasms with MCC* | $12,851 |
| 181 | Respiratory Neoplasms with CC* | $7,793 |
| 182 | Respiratory Neoplasms without CC/MCC | $5,414 |
| ACES System | ||
| 186 | Pleural Effusion with MCC | $11,341 |
| 187 | Pleural Effusion with CC | $7,197 |
| 188 | Pleural Effusion without CC/MCC | $5,219 |
| ACES System + Thorascopy and/or Biopsy | ||
| 166 | Other Respiratory System OR Procedures with MCC | $27,198 |
| 167 | Other Respiratory System OR Procedures with CC | $13,123 |
| 168 | Other Respiratory System OR Procedures without CC/MCC | $9,943 |
*MCC: Major complication or comorbidity; CC: Complication or comorbidity.
For questions regarding coding, coverage or payment of the ACES System, contact our Reimbursement Hotline at: jgarfield@insearch-solutions.com
Medicare hospital outpatient setting2
Hospitals are reimbursed by Medicare for outpatient procedures and services performed under the Outpatient Prospective Payment System (OPPS), which utilizes the CY2026 Ambulatory Payment Classification (APC) system.
Medicare Coding and Payment - Medicare Traditional (Fee for Service)
(New Technology APC, eff 10-1-2025)
Effective October 1, 2025, CMS established HCPCS code C8006, insertion of a pleural-peritoneal shunt with an intercostal pump chamber, to describe the ACES procedure.3
| HCPCS Code* | Description | 2026 APC/Status Indicator | Medicare 2026 Hospital Outpatient Natl Payment |
|---|---|---|---|
| ACES System Implant – Code separately for thoracoscopy, if performed | |||
| C8006 | Insertion of pleural-peritoneal shunt with intercostal pump chamber, including imaging, injection(s) of contrast with radiological supervision and interpretation, when performed | 5342/J1 Level 2 Abd/Peritoneal/Biliary and Related Procedures |
$6,614 |
NOTE: All procedures performed same day in hospital outpatient setting are packaged into highest paying J1 status code.
Commercial Payors (including Medicare Advantage)
New Technology APCs are part of the payment system for Traditional Medicare (Fee for Service) outpatient services, not necessarily Medicare Advantage. Medicare uses New Technology APCs to pay for new outpatient services until enough claims data is collected to assign them to a standard clinical APC. This is a separate process from how Medicare Advantage plans are paid, and their use of new technology is subject to the plan’s own benefits and medical review.
Commercial Payor/Medicare Advantage Coding Considerations
While many commercial payors follow Traditional Medicare when it comes to coding options, it is not a requirement. Providers should check with payors to determine if they will accept the C-code or prefer existing or unlisted CPT codes.
In the event the payor does not accept the new C-code (C8006), the following 2 options may be considered for hospital outpatient coding.
Coding Option 1: Combination of Existing Codes CPT Code
ACES System Implant – Code all procedures performed, including thoracoscopy, when applicable
| CPT Code | Description |
|---|---|
| 49418 AND |
Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous |
| 32556 | Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance |
Coding Option 2: Unlisted Code
Coding is at the discretion of the provider based on medical necessity and documentation; the unlisted code may be considered at payor direction or
if no specific code or combination of codes exists.
| CPT Code | Description |
|---|---|
| 32999 | Unlisted procedure, lungs and pleura |
More coding and billing information is available in the ACES coding and reimbursement guide
Physician services4
Physicians are reimbursed for services under the Medicare Physician Fee Schedule (MPFS) using CPT codes. Coding is at the discretion of the provider based on medical necessity and documentation.
Coding Option 1
- Generally, diagnostic procedures performed on the same date of service are billed separately (e.g., ultrasound evaluation, thoracoscopy)
- Use of visualization (e.g., laparoscopy, fluoroscopic guidance and contrast injection) is considered included in the surgical procedure and not separately reported
| CPT Code | Description | 2026 Physician Work RVUs | Medicare 2026 Physician Payment (Facility)* | Medicare 2026 Physician Payment (Non-Facility)* |
|---|---|---|---|---|
| ACES System Implant - Code all procedures performed | ||||
| 49418 | Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous | 3.86 | $175 | $940 |
| 32556 | Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance | 2.44 | $112 | $842 |
*Facility payment is made when physician performs the procedure in a facility setting such as hospital; Non-facility payment is made when physician performs procedure or service in office or freestanding facility; payment in this site of service is higher to account for overhead costs, personnel, supplies, etc. Multiple procedure reduction applies; highest paying procedure 100%, secondary procedures 50%, add-on codes 100%.
Coding Option 2
If the provider feels there are no codes that accurately describe the implant procedure, unlisted code 32999 (“Unlisted procedure, lungs and pleura”) may be an appropriate option.
| CPT Code | Description | Medicare 2026 Physician Payment |
|---|---|---|
| 32999 | Unlisted procedure, lungs and pleura | No RVUs or payment assigned |
More coding and billing information is available in the ACES coding and reimbursement guide
The ACES implant is approved for sale in the USA. Caution: Federal (United States) law restricts this device to sale by or on order of a physician. Prior to use, please see the Instructions for Use for a complete listing of Indications, Contraindications, Warnings, Precautions, Potential Complications, and Insertion Instructions.