Cook Medical has announced that effective October 1, 2013, its Zilver PTX drug-eluting peripheral stent qualifies for new-technology add-on payments under Medicare’s hospital inpatient prospective payment system.
In order to qualify for add-on reimbursement, Zilver PTX technology had to satisfy the following three conditions.
First, a new technology should display a substantial clinical improvement.
Second, the data that Medicare uses to set payments for the new technology under the Medicare severity diagnosis-related groups (MS-DRGs) must not be available.
Third, the MS-DRG payment rate that otherwise applies to the new technology must be inadequate.
Cook Medical reimbursement director and medical science officer Dr Jim Gardner noted this is great news for Medicare beneficiaries who suffer from peripheral arterial disease, and for US hospitals that treat these patients.
The add-on reimbursement will apply for two to three years after which Medicare will determine the ‘permanent’ diagnosis-related group assignments for Zilver PTX procedures, Gardner added.
Hospitals are eligible to receive $1,705.25 in additional reimbursement for inpatient procedures with Zilver PTX stents during the add-on payment period.
However, physician reimbursement, hospital reimbursement for outpatient procedures, or ambulatory surgery center (ASC) reimbursement for Zilver PTX stenting procedures performed in the ASC will remain unaltered.
"Now that Medicare has recognized the benefits of this technology, we encourage our hospital customers to discuss similar reimbursement policies with the commercial insurance plans they contract with," Gardner added.