Respiratory imaging technology company 4DMedical Limited (ASX:4DX) has confirmed the inclusion of 4DMedical’s CT LVAS technology to existing Category III Current Procedural Terminology (CPT) codes in the US.
This provides with associated access to the US Centres for Medicare & Medicaid Services (CMS) annual, final payment rates for hospital outpatient-based services, effective immediately.
Widened access to CT LVAS for patients at Medicare-funded facilities
The American Medical Association (AMA) CPT Editorial Panel Review has informed 4DMedical of its determination that the application for an individual code for CT LVASTM was not required. After review and consideration of the information provided by 4DMedical, the CPT panel, consisting of 14 Medical societies inclusive of four Radiology societies, identified two existing Category III CPT codes (0721T and 0722T) that can be used for reimbursement of CT LVASTM.
These existing codes already attract a reimbursement payment of US$650.50 per scan under the 2024 Medicare rulings for eligible facilities. As the codes are already in place with a reimbursement payment attached, CT LVASTM scans conducted in a US hospital outpatient facility for Medicare beneficiaries may be billed to CMS from today.
CMS reimbursement provides access to CT LVASTM at over 4,000 Medicare-certified hospitals across the U.S., ensuring that CT LVASTM technology, which can be performed on existing CT scanners, is available to Medicare beneficiaries suffering from lung disease. This provides a funding source for providers of the technology beyond full out-of-pocket payment. Importantly, this benchmark payment level, set for hospital outpatient procedures, serves as a guide for private health insurers in determining their pricing levels, typically at a much higher rate.
“I am very excited by this progress in the commercialisation of our technology, and the positive impact this CPT code and associated reimbursement will have upon doctors and their patients,” 4DMedical MD/CEO and Founder Andreas Fouras said.
“An identified Medicare reimbursement of US$650.50 per scan provides direct access to CT LVAS for the 66 million Americans enrolled in Medicare.
“The routine use of chest CT in the clinical work up of respiratory patients, combined with the recognised value of our scan, makes the AMA’s decision one of the most significant breakthroughs to date in our history.
“Furthermore, I believe this decision helps to establish the appropriate pricing of our technology within the VA.
“I am excited to note that this news comes less than six months following the FDA clearance of CT LVAS, demonstrating growing strength in our team and our reputation with key organisations such as the AMA and associated medical societies. This bodes well for continued success with reimbursement of future products such as IQ-UIP and CT:VQ, both expected to be filed with the FDA in 2024.”
