CMS updates reimbursement calculation for bone graft substitute payment based on setting
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CMS published an update to the reimbursement calculation used to determine transitional pass-through payment for the category of bone substitute products that includes Wright Medical Group’s Augment Regenerative Solutions products.
According to a July 20 press release from Wright Medical Group N.V., the transitional pass-through payment for this device category, which only includes the Augment bone graft and injectable devices as of now, was originally implemented on Jan. 1, 2020.
“Based on this update, when hindfoot and ankle fusions are performed in the hospital outpatient and ambulatory surgical center settings of care, the facility will be paid for the incremental cost of Augment, thereby facilitating Medicare beneficiary access to the advantages of Augment by removing an economic barrier,” according to the press release.
The transitional pass-through payment now reimburses hospital outpatient centers and ASCs for the incremental cost of Augment bone graft substitute, which is used in hindfoot and ankle fusion procedures.
According to the release, the update was made retroactive to Jan. 1, 2020.
The existing transitional device pass-through code of C1734 may be used to bill for Augment for hindfoot and ankle fusion procedures when used during treatment of Medicare beneficiaries enrolled in Medicare Part B under the traditional Medicare program, as noted in the release.
Robert Palmisano, president and CEO of Wright Medical Group, said in the release, “The update to the transitional pass-through payment in the outpatient setting will help ensure health care providers have access to Augment Regenerative Solutions, which offer a clear patient benefit by eliminating the complications of the additional surgery required to harvest autograft that can result in site-specific complications and/or prolonged harvest site pain in some patients.”
Gregory C. Berlet, MD, FRCS(C), FAOA, an Orthopedics Today Editorial Board Member who practices at Orthopedic Foot and Ankle Center in Westerville, Ohio, told Healio Orthopedics, “While the CMS reimbursement is clearly instrumental for increased Medicare patient access to Augment, this is only made possible by truly meaningful and impactful clinical data. Pivotal to the CMS decision was our subset analysis demonstrating that, for patients receiving Augment, there was a two times odds ratio for fusion success in patients over 65 [years old] when compared to those who received autograft.”
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