ACES® Coding, Coverage, and Reimbursement
Pleural Dynamics recognizes the importance of helping healthcare providers, facilities, and patients understand the reimbursement process for the ACES® procedure. We offer resources and guidance to help address questions about insurance coverage, coding, and reimbursement requirements across different health plans.
The information below provides an overview of key reimbursement considerations and resources to help navigate the process.
Coding and payment across inpatient and outpatient settings
Medicare reimburses facilities for outpatient procedures and services under the Outpatient Prospective Payment System (OPPS), which uses the CY2026 Ambulatory Payment Classification (APC) system, and for inpatient services, where diagnosis and procedure codes map to a Diagnosis Related Group (DRG). Physician services are billed separately regardless of place of service using the appropriate CPT codes.
Inpatient Setting
The ACES procedure can be billed with an HCPCS code, which maps to an APC.
Outpatient Setting
Existing DRGs and ICD-10 procedure codes can be used to bill the ACES procedure.
Physician Payment (Inpatient & Outpatient)
The same set of CPT codes is used when performing the ACES procedure.
Access Coding and Reimbursement Guide
The ACES coding guide describes potential coding approaches for the facilities and physician services. Code selection should reflect the procedure performed, supporting documentation, and applicable coding rules and payer requirements.
Hospital inpatient setting
Inpatient Procedure Codes ICD-10 diagnosis and procedure 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.
| 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 |
Select diagnosis and procedure codes based on the patient’s condition, the documented procedure, and the code set applicable to the discharge date.
Diagnosis coding and inpatient procedure coding are separate. Refer to the ACES Coding & Reimbursement Guide for reviewed examples and confirm that each code accurately reflects the medical record.
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.
Medicare inpatient payment depends on the complete coded discharge record and applicable payment rules. No specific MS-DRG assignment or payment amount is guaranteed for an ACES case.
Separately reported codes do not necessarily result in separate payments. Some services may be included in a single facility payment.
Need Reimbursement Information?
Contact Pleural Dynamics Reimbursement Support at [email protected] or 763-349-1649 with questions about ACES coding and reimbursement resources.
For patient-specific coverage, prior authorization, or claim questions, contact the patient’s insurance plan directly.
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)
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.
Medicare Advantage and Commercial Insurance
Review the patient’s plan-specific coverage policy, authorization requirements, and facility billing instructions before the procedure. Some plans may limit or exclude coverage.
If a Commercial or Medicare Advantage health plan does not allow reporting HCPCS C8006, contact the Pleural Dynamics Reimbursement Team at [email protected] or 763-349-1649 for payer-specific coding and reimbursement considerations. Do not assume that traditional Medicare’s coding or payment approach applies.
More coding and billing information is available in the ACES coding and reimbursement guide
Physician Coding Considerations
Possible Physician Coding
- 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 (e.g., 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 the physician performs the procedure in a facility setting such as a hospital; non-facility payment is made when the physician performs the procedure or service in an 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%.
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.