CMS issued its final Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ASC) Payment System rule for 2025. The rule goes into effect on Jan. 1, 2025, implementing the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act. NOPAIN mandates separate Medicare payment for qualifying non-opioid drugs and devices.
According to a news release, NOPAIN, passed as part of the Consolidated Appropriation Act of 2023, aims to increase patient access to non-opioid drugs and devices used to manage pain in Hospital Outpatient (HOPD) and ASC settings by providing additional Medicare reimbursement for qualifying non-opioid items.
The final rule confirmed that Avanos Medical’s ON-Q and ambIT infusion systems meet qualifying requirements. ON-Q provides elastomeric infusion and ambIT provides disposable electronic infusion. Both deliver non-opioid pain management therapy and become eligible for separate payment for the first time under NOPAIN.
ON-Q and ambIT each received a unique, brand-specific Healthcare Common Procedure Coding System (HCPCS) code. ON-Q has a payment limitation of up to $2,284.98 and ambIT goes up to $2,284.98. NOPAIN mandates separate payment for qualified treatments through Dec. 31, 2027, when provided with a covered surgical procedure.
Avanos says this makes its infusion systems the first and only pain pumps included under the policy.
“The inclusion of ON-Q and ambIT pumps under the NOPAIN Act is a testament to the devices’ effectiveness in reducing opioid use after surgery. We commend CMS for their commitment to improving patient access to non-opioid therapies, and we are dedicated to collaborating with healthcare professionals to advocate for proven non-opioid treatments,” said Michael Greiner, Avanos Medical’s interim CEO.
