Medicare Issues Final Rule that Increases Payment Rates for iTind Procedure Performed in Outpatient Settings

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CENTER VALLEY, Pa., Nov. 3, 2022 /PRNewswire/ -- Olympus Corporation, a global medical technology company committed to making people's lives healthier, safer, and more fulfilling, announced that the Centers for Medicare and Medicaid Services (CMS) will increase payment rates for the iTind™ procedure performed in the hospital-based outpatient department (HOPD) and Ambulatory Surgical Center (ASC). The proposed rule was finalized and announced on November 1, 2022, and rates will be effective January 1, 2023.

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Retrieved on: 
Thursday, November 3, 2022
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Man, Patient, Prospective payment system, OPPS, BPH, Health care, Science, Ageing, Medicare, Multimedia, UNITE, Elective surgery, Endoscopy, Centers for Medicare & Medicaid Services, Urination, Olympus, PMID, Laparoscopy, Quality of life, FACS, Olympus Corporation, Center, LUTS, Urine, APC, Hotlines, Clinical study design, CMS, ASC, Technology, MBA, Urinary tract infection, Treatment, MD, Blood, Program, Solution, Pharmaceutical industry, Hospital, Medical imaging
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PENNSYLVANIA, AMERICAS
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Olympus
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Tokyo:TSE7733
Summary
Key Points: 
  • The proposed rule was finalized and announced on November 1, 2022, and rates will be effective January 1, 2023.
  • The final CMS CY2023 Outpatient Prospective Payment System (OPPS) Rule increases payment rates for code C9769 covering the iTind procedure in HOPD and ASC facilities.
  • The rule changes are as follows:
    "We applaud CMS for recognizing the value of the iTind procedure.
  • Clinical evidence demonstrates that the iTind procedure safely and effectively relieves symptoms while preserving sexual function.


Medicare Issues Final Rule that Increases Payment Rates for iTind Procedure Performed in Outpatient Settings

CY2023 Fee Schedules Apply to Hospital Outpatient Departments and Ambulatory Surgical Centers

CENTER VALLEY, Pa., Nov. 3, 2022 /PRNewswire/ -- Olympus Corporation, a global medical technology company committed to making people's lives healthier, safer, and more fulfilling, announced that the Centers for Medicare and Medicaid Services (CMS) will increase payment rates for the iTind™ procedure performed in the hospital-based outpatient department (HOPD) and Ambulatory Surgical Center (ASC). The proposed rule was finalized and announced on November 1, 2022, and rates will be effective January 1, 2023.

The final CMS CY2023 Outpatient Prospective Payment System (OPPS) Rule increases payment rates for code C9769 covering the iTind procedure in HOPD and ASC facilities. The rule changes are as follows:

  • In the HOPD:
    • CMS reclassified the urology Ambulatory Payment Classification (APC) from a level 5 to a level 6
    • CMS finalized a national average payment rate of $8,221.74 per procedure in OPPS payments
  • In the ASC:
    • CMS finalized a national average payment rate of $7,274.78 per procedure in ASC payments

The new payment rate expands access to care for Medicare beneficiaries who could benefit from this new minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

"We applaud CMS for recognizing the value of the iTind procedure. After significant evidence-based engagement with the agency, Olympus successfully demonstrated the value and science behind this technology, leading CMS to revise the APC assignment and enhance the payment rate, which will in turn support patient access to this important procedure," said Paul Skodny, Executive Director for Health Economics and Market Access at Olympus Corporation of the Americas.

"Olympus is changing the treatment paradigm for BPH by providing solutions beyond medical management and surgical intervention, which both come with some unwanted side effects," said Ross "Rusty" Segan, MD, MBA, FACS, Chief Medical Officer for Olympus Corporation. "With advancements in minimally invasive BPH therapies, patients and providers have treatment options that allow for improved outcomes, such as maintaining sexual function. Clinical evidence demonstrates that the iTind procedure safely and effectively relieves symptoms while preserving sexual function."i,ii

The iTind procedure is indicated for men aged 50 and older and involves the temporary implantation of a nitinol device designed to reshape the prostatic urethra, which allows urine to flow more freely.i The procedure can be performed in an HOPD, ASC or clinical office. As with any medical procedure, there are potential risks. Implantation of the iTind device may cause pelvic discomfort, blood in urine and painful or urgent urination. In rare cases, the iTind procedure may cause urinary tract infection or a sudden difficulty to urinate.

Patients who are candidates for the iTind procedure may be assisted in navigating medical insurance systems through the Olympus UNITE program. Olympus UNITE may include services such as pre-authorization and patient appeals services, strategic reimbursement support, and hotlines to support coverage, coding, and payment concerns. Healthcare providers, insurance staff, and patients with questions about the program should email [email protected].

About Olympus

A leading medical technology company, Olympus uses innovative capabilities in medical technology, therapeutic intervention, and precision manufacturing to help healthcare professionals deliver diagnostic, therapeutic, and minimally invasive procedures to improve clinical outcomes, reduce overall costs, and enhance the quality of life for patients. Olympus' portfolio includes endoscopes, laparoscopes, and video imaging systems, as well as surgical energy devices, system integration solutions, medical services, and a wide range of endotherapy instruments. For more information, visit medical.olympusamerica.com.

i Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology. 2021 Jul;153:270-276. doi: 10.1016/j.urology.2020.12.022. Epub 2020 Dec 26. PMID: 33373708.
ii De Nunzio C, Cantiello F, Fiori C, Crocerossa F, Tognoni P, Amparore D, Baldassarri V, Elbers JR, Sancha FG, Porpiglia F. Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study. World J Urol. 2021 Jun;39(6):2037-2042. doi: 10.1007/s00345-020-03418-2. Epub 2020 Aug 26. PMID: 32851439.

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