4 procedures getting CMS reimbursement boosts at ASCs

CMS is providing increased payments for several new products and procedures, including these four that are intended for spine surgery, cardiology, gynecology and sleep apnea.

1. CMS awarded Aprevo, a patient-specific spine implant, a transitional pass-through payment, providing outpatient facilities with an incremental Medicare payment for using the device. The nod comes after the agency granted Aprevo the new technology add-on payment, which provides additional payment in the inpatient setting. Both updates went into effect Oct. 1.

2. The Guardian, an implantable acute coronary syndrome event detector, qualified for the CMS transitional pass-through payment as part of the 2022 Medicare Hospital Outpatient Prospective Payment System. The device uses machine learning to establish a patient's baseline once implanted, then records the heart's electrical activity to detect and alert for heart attacks. The transitional pass-through payment will begin Jan. 1 and continue for two to three years.

3. CMS added a new CPT code to describe the procedure associated with the EnPlace system, a minimally invasive meshless approach for pelvic floor fixation. EnPlace is positioned for appropriate payment as a level 5 GYN procedure and designated as device intensive, which increases access to the procedure in the ASC setting.

4. The agency raised the rate for closed-loop hypoglossal nerve stimulation, a sleep apnea procedure, by more than $7,000. Payment for the procedure was set at about $17,000 in the 2022 ASC final rule, but CMS acknowledged that a default device offset of 31 percent was mistakenly used for the first calculation. Effective Jan. 1, the updated reimbursement rate will be set at the national average of $24,828.64.

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