Inspire Medical Systems (NYSE: INSP) says CMS has answered some questions about how it will reimburse its implantable sleep apnea treatment device.
The Golden Valley, Minnesota–based company announced on November 10 that CMS has published updated addendum files for the 2022 ambulatory surgery center payment system.
The update included an assigned device offset percentage and final payment rate for new CPT code 64582 — already approved by the AMA CPT Editorial Panel for closed-loop hypoglossal nerve stimulation.
The updated files reflect the national average ASC reimbursement rate for CPT code 64582 of $24,828.64 — versus an initial proposal to peg it at roughly $17,000. The new rate goes into effect on January 1, 2022.
SVB Leerink Research analysts previously noted on November 2 that a CMS final rule published after market close still showed a roughly $17,000 reimbursement range, though Inspire Medical Systems management pointed out CMS commentary in the final rule that suggested more was to come.
Inspire Medical Systems CEO Tim Herbert said in the November 10 news release: “It was important for CMS to update the data tables as quickly as they did to allow ASCs to continue scheduling patients for Inspire therapy into 2022 without the uncertainty of the Medicare reimbursement rates. Physicians, hospitals and ASC now have a stable coding methodology and reimbursement clarity effective January 1, 2022.”
