CMS Approves New Technology Add-On Payment for Gore's Excluder Iliac Branch Endoprosthesis

September 27, 2016—Gore & Associates announced that the Centers for Medicare & Medicaid Services (CMS) has granted the company’s Excluder iliac branch endoprosthesis (IBE) new technology status. The Excluder IBE, which was approved by the US Food and Drug Administration in early 2016, is specifically designed for the endovascular treatment of common iliac artery and aortoiliac aneurysms.

Beginning October 1, facilities using the Excluder IBE in conjunction with Gore’s Excluder AAA device for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms are eligible for a new technology add-on payment (NTAP) of up to $5,250 per case, in addition to the applicable base payment for the Medicare Severity Diagnosis-Related Group (MS-DRG).

The company advised that recognition of new technology status is based on the technology meeting three criteria: (1) it must be a new device and/or application, (2) demonstrate substantial clinical benefit to the patient, and (3) have an associated cost not already represented in the current base rate. NTAPs are made for no less than 2 years and no more than 3 years, after which the DRG base rates are adjusted to reflect facility-reported costs and the utilization rate of the new technology.

Gore stated that it previously succeeded in a petition to CMS for the reclassification of EVAR, creating two new DRGs with increased hospital base reimbursement effective federal fiscal year 2016. 

This NTAP, along with the DRG base increase resulting from the 2016 DRG reclassification, will greatly improve the alignment of hospital payment and average resource consumption, making sure hospitals are more appropriately compensated for using this new technology, stated the company.