The regional Medicare administrative contractor Novitas Solutions has set CPT codes 93243 and 93247 at roughly $223 and $233 respectively — news first reported by analysts this morning. The rates are retroactive to Jan. 1, 2022.
“We would like to thank Novitas, and the other MACs, for their continued engagement and efforts to better understand long-term continuous ECG monitoring, the clinical benefits that it provides to patients and the costs and resources that go into to delivering the service,” iRhythm CEO Quentin Blackford said in a news release.
iRhythm added that the new Novitas rates, had they been in effect in 2021, would have boosted revenue by 10%.
IRTC shares were up more than 27% to $130.04 apiece by the close of trading today. MassDevice‘s MedTech 100 Index, which includes stocks of the world’s largest medical device companies, was down slightly.
iRhythm officials had previously expressed disappointment in November 2021 when CMS recommended a $200 price for an EKG patch but left it up to the administrative contractors to make a final call.
The new rates out of Novitas are more than double the $103 and $115 rates set in April 2021, according to BTIG.
“This looks like a positive update to us, but we await further clarification and detail from iRhythm,” BTIG analysts Marie Thibault and Sam Eiber said earlier.
Truist analysts David Rescott and Samuel Brodovsky also sounded optimistic: “Based on the newly revised rates, if we simply assume that reimbursement goes to around $230 (given that the vast majority of ZioXT patches are worn for 7–15 days) and there is no change to our current assumed rate of commercial payor declines, this would yield a revenue estimate of $384M in 2022 (+21%Y/Y growth) and $453M in 2023 (+18% growth).”
The company presents tomorrow at the annual J.P. Morgan Healthcare Conference.
Remote EKG monitoring companies have sought to improve on traditional Holter monitors. iRhythm’s Zio XT cardiac monitor, for example, goes on a person’s chest for up to 14 days — with no need for further interaction. It then gets mailed in for data analysis.
Other companies active in the space include BardyDx, now part of Baxter, and AliveCor.
Updated with comments from iRhythm.