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February 18, 2015
Drug-Coated Balloons Gain CMS Transitional Pass-Through Payment for Outpatient Use
February 19, 2015—Medtronic plc and C.R. Bard have announced that the Centers for Medicare & Medicaid Services (CMS) has approved a transitional pass-through payment for peripheral vascular drug-coated balloon (DCB) use under the Medicare hospital outpatient prospective payment system (OPPS).
Two DCBs are currently on the market in the US: Bard's Lutonix received US Food and Drug Administration approval in October 2014, and Medtronic's In.Pact Admiral gained approval in January 2015. According to the companies' announcements, the CMS provision aims to cover the additional cost to US-based hospitals for treating Medicare beneficiaries using DCBs in the outpatient setting.
This reimbursement provision, which will take effect starting on April 1, 2015, will remain in effect for 2 to 3 years. The companies advise that the Healthcare Common Procedure Coding System (HCPCS) code for this new device category will be C2623 (catheter, transluminal angioplasty, drug-coated, non-laser).
Medtronic also states that Medicare is currently reviewing a similar provision for use of the DCB in the inpatient setting. A decision on a new technology add-on payment for the hospital inpatient prospective payment system (IPPS) is expected sometime this summer.
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