Intersect ENT (NSDQ:XENT) announced today that it received consolidated Medicare coverage for its Sinuva sinus implant.
Menlo Park, Calif.-based Intersect ENT said in a news release that CMS published an average selling price (ASP) for the Sinuva implant, providing predictability, transparency and confidence of reimbursement for providers and payers in the future.
Sinuva is a non-surgical, corticosteroid-eluting implant for treating nasal polyps in adult patients who have had ethmoid sinus surgery. It is made of a self-expanding, bioabsorbable implant structurcombinedne with the targeted delivery of mometasone furoate, an anti-inflammatory corticosteroid.
The implant offers localized drug delivery for up to 90 days directly at the disease site and can be administered in an office.
Previously, a single code covered Intersect ENT’s Propel and Sinuva bioabsorbable implant product lines. However, in January, CMS created separate and distinct codes, while the ASP has now been attached to the code for the Sinuva mometasone furoate sinus implant.
Additionally, CMS confirmed the consolidation of all coding for Sinuva under the new code, giving Sinuva “pass-through” status in ambulatory care settings for Medicare patients. Intersect ENT said the separate codes would positively impact patient and physician access by improving accuracy in claims adjudication, supporting expanded use at multiple service sites, and providing greater clarity of coverage for payers and providers.
“We are pleased that CMS consolidated Sinuva coverage to a single code and published a Sinuva ASP. These actions will help better inform ENT surgeons of the amount of implant reimbursement they can expect regardless of setting of care, thereby greatly reducing the uncertainty that can come with claims submissions,” Intersect ENT president & CEO Thomas A. West said in the release. “CMS’s recent decisions will also clearly differentiate coding for Sinuva and Propel, two very different products. This will serve to simplify and streamline coding and reimbursement across our portfolio and will support evidence-based and cost-effective care across the continuum of need in chronic rhinosinusitis.”