ON-Q* Elastomeric Infusion Pump and ambIT* Disposable Electronic Infusion Pump to Receive Separate Payment Under NOPAIN Act Starting January 1, 2025

Rhea-AI Summary

The Centers for Medicare and Medicaid Services (CMS) announced that Avanos Medical's ON-Q elastomeric infusion pump and ambIT disposable electronic infusion pump will receive separate Medicare payments under the NOPAIN Act starting January 1, 2025. This decision, part of the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ASC) Payment System rule for 2025, aims to enhance access to non-opioid pain management in HOPD and ASC settings. The NOPAIN Act, effective until December 31, 2027, provides additional Medicare reimbursement for qualifying non-opioid items to reduce opioid reliance. Both ON-Q and ambIT pumps will have unique HCPCS codes (C9804 and C9806) and a payment limit of up to $2,284.98 each. This move by CMS is a significant step in promoting safer pain management alternatives for Medicare beneficiaries.

Positive

• CMS confirmed separate Medicare payment for ON-Q and ambIT pumps starting January 1, 2025.
• Unique HCPCS codes for ON-Q (C9804) and ambIT (C9806) with up to $2,284.98 payment limit.
• Inclusion under NOPAIN Act enhances access to non-opioid pain management.
• CMS's decision supports reducing opioid reliance in postoperative care.

Negative

• None.

ALPHARETTA, Ga., Nov. 11, 2024 /PRNewswire/ -- Avanos Medical, Inc. (NYSE: AVNS) announced today that the Centers for Medicare and Medicaid Services (CMS) has issued its final Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ASC) Payment System rule for 2025. This rule, effective Jan. 1, 2025, implements the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act that mandates separate Medicare payment for qualifying non-opioid drugs and devices.

The NOPAIN Act, 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.

In the final rule, CMS confirmed that both the Avanos ON-Q elastomeric infusion pump and the Avanos ambIT disposable electronic infusion pump non-opioid pain management delivery systems meet qualifying requirements, marking a significant milestone as both become eligible for separate payment for the first time under the NOPAIN Act. HOPDs and ASCs that use these products will receive separate Medicare reimbursement in addition to the related APC payments beginning January 1, 2025.

Both ON-Q and ambIT infusion delivery systems each received a unique, brand-specific Healthcare Common Procedure Coding System (HCPCS) code eligible for separate payment in the HOPD and ASC settings. This decision by CMS is a pivotal step towards enhancing access to clinically proven non-opioid treatments for Medicare beneficiaries in HOPD and ASC settings.

The payment limitation calculated and published by CMS is up to $2,284.98 for the ON-Q infusion system and up to $2,284.98 for the ambIT infusion system. The new unique HCPCS code C9804 for ON-Q and HCPCS code C9806 for ambIT can be used on claim submissions beginning for services rendered on January 1, 2025. 

The NOPAIN Act mandates that CMS provide separate payment for qualified non-opioid treatments through December 31, 2027 when provided with a covered surgical procedure. The ON-Q and ambIT devices are now the first and only infusion pain pumps included under this policy, which aims to reduce reliance on opioids in postoperative care. CMS will review and approve eligible products on an annual basis during this 3-year program. This initiative is part of a broader strategy by CMS to combat the opioid crisis by promoting safer pain management alternatives.

Michael Greiner, Avanos Medical's interim CEO, praised the CMS decision, stating, "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."

The ON-Q elastomeric and ambIT electronic infusion pumps have been validated by CMS as a treatment that can effectively replace or reduce postoperative opioid use, as proven by clinical trials and peer-reviewed data. These innovative devices continuously deliver local anesthetic, providing patients with targeted pain relief while minimizing opioid consumption.

For more information on ON-Q and ambIT coverage under the NOPAIN Act, please click here: Avanos NOPAIN Act.

For inquiries regarding the NOPAIN Act, contact our Market Access and Reimbursement Team at reimbursement@avanos.com.

To view the final rule in its entirety, visit the Federal Register.

About Avanos Medical
Avanos Medical (NYSE: AVNS) is a medical technology company focused on delivering clinically superior medical device solutions that will help patients get back to the things that matter. Headquartered in Alpharetta, Georgia, Avanos is committed to addressing some of today's most important healthcare needs, including providing a vital lifeline for nutrition to patients from hospital to home, and reducing the use of opioids while helping patients move from surgery to recovery. Avanos develops, manufactures and markets its recognized brands globally and holds leading market positions in multiple product categories. For more information, visit www.avanos.com and follow Avanos Medical on X (@AvanosMedical), LinkedIn and Facebook.

*Registered Trademark or Trademark of Avanos Medical, Inc., or its affiliates. © 2018-2024 AVNS. All rights reserved.

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SOURCE Avanos Medical

FAQ

When will Avanos Medical's ON-Q and ambIT infusion pumps receive separate Medicare payments?

Starting January 1, 2025.

What is the purpose of the NOPAIN Act mentioned in the PR?

To increase patient access to non-opioid drugs and devices for pain management and reduce opioid reliance.

What are the HCPCS codes for ON-Q and ambIT infusion pumps?

HCPCS code C9804 for ON-Q and HCPCS code C9806 for ambIT.

How much is the payment limit for ON-Q and ambIT infusion pumps under the new CMS rule?

Up to $2,284.98 each.

Until when does the NOPAIN Act mandate separate payment for qualified non-opioid treatments?

Until December 31, 2027.