Inspire Medical Systems, Inc, a medical technology company focused on the development and commercialization of innovative and minimally invasive solutions for patients with obstructive sleep apnea, is providing an update on the 2022 reimbursement payment rates for Inspire procedures performed in ambulatory surgical centers (ASCs).
The Centers for Medicare and Medicaid Services (CMS) recently published updated addendum files for the 2022 ASC payment system, including updating the assigned device offset percentage and final payment rate for new CPT code 64582. This code was previously approved for closed-loop hypoglossal nerve stimulation by the AMA CPT Editorial Panel and is the new CPT code to report for Inspire procedures effective January 1, 2022.
CMS previously published the final OPPS/ASC rules including their statement accepting the Medicare Advisory Panel on Hospital Outpatient Payment (HOP Panel) recommendation to recalculate the ASC payment that was initially proposed in July 2021 to be approximately $17,000. CMS acknowledged that a default device offset of 31% was mistakenly used for the first calculation and that claims data reported for CPT code 64568 should have been used instead, as this code is the current code to report for Inspire procedures.
While CMS published the OPPS/ASC final rules, they had not yet updated the addendum files, which provides the reimbursement levels for procedures performed in an ASC. Today, CMS updated the addendum files and the device offset percentage for CPT code 64582. The updated files reflect the national average reimbursement rate for CPT code 64582 of $24,828.64. This updated rate for an ASC is effective January 1, 2022. The final device offset percentage used in the addendum was 88.07%.
Tim Herbert, CEO of Inspire, says in a release, “We appreciate the responsiveness shown by CMS following the panel review and issuance of the OPPS rules. 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.”