ON-Q* Elastomeric Infusion Pump and ambIT* Disposable Electronic Infusion Pump to Receive Separate Payment Under NOPAIN Act Starting January 1, 2025
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.
I Centers for Medicare and Medicaid Services (CMS) hanno annunciato che le pompe per infusione elastomerica ON-Q di Avanos Medical e la pompa per infusione elettronica usa e getta ambIT riceveranno pagamenti separati da Medicare ai sensi del NOPAIN Act a partire dal 1 gennaio 2025. Questa decisione, parte del sistema di pagamento prospettico per ospedali e centri chirurgici ambulatoriali (OPPS) e del sistema di pagamento per centri chirurgici ambulatoriali (ASC) di Medicare per il 2025, mira a migliorare l'accesso alla gestione del dolore non oppioide negli ambienti HOPD e ASC. Il NOPAIN Act, in vigore fino al 31 dicembre 2027, fornisce rimborsi aggiuntivi di Medicare per articoli non oppioidi qualificati per ridurre la dipendenza dagli oppioidi. Le pompe ON-Q e ambIT avranno codici HCPCS unici (C9804 e C9806) e un limite di pagamento fino a $2,284.98 ciascuna. Questa iniziativa del CMS rappresenta un passo importante nella promozione di alternative di gestione del dolore più sicure per i beneficiari di Medicare.
Los Centros de Servicios de Medicare y Medicaid (CMS) anunciaron que la bomba de infusión elastomérica ON-Q de Avanos Medical y la bomba de infusión electrónica desechable ambIT recibirán pagos separados de Medicare bajo la Ley NOPAIN a partir del 1 de enero de 2025. Esta decisión, parte del Sistema de Pago Prospective para Hospitales Ambulatorios (OPPS) y del Sistema de Pago para Centros Quirúrgicos Ambulatorios (ASC) de Medicare para 2025, tiene como objetivo mejorar el acceso a la gestión del dolor no opioide en entornos HOPD y ASC. La Ley NOPAIN, vigente hasta el 31 de diciembre de 2027, proporciona reembolsos adicionales de Medicare para artículos no opioides calificados para reducir la dependencia de opioides. Ambas bombas, ON-Q y ambIT, tendrán códigos HCPCS únicos (C9804 y C9806) y un límite de pago de hasta $2,284.98 cada una. Este movimiento de CMS es un paso significativo en la promoción de alternativas más seguras para la gestión del dolor para los beneficiarios de Medicare.
메디케어와 메디케이드 서비스 센터(CMS)는 Avanos Medical의 ON-Q 엘라스토머릭 주입 펌프와 ambIT 일회용 전자 주입 펌프가 2025년 1월 1일부터 NOPAIN 법에 따라 메디케어에서 별도로 지불될 것이라고 발표했습니다. 이 결정은 2025년 메디케어 병원 외래 진료 프로스펙티브 지불 시스템(OPPS)과 메디케어 외래 수술 센터(ASC) 지불 시스템 규칙의 일환으로, HOPD 및 ASC 설정에서 비오피오이드 통증 관리에 대한 접근을 향상시키는 것을 목표로 합니다. NOPAIN 법은 2027년 12월 31일까지 유효하며, 오피오이드 의존도를 줄이기 위해 자격을 갖춘 비오피오이드 품목에 대한 추가 메디케어 환급을 제공합니다. ON-Q 및 ambIT 펌프는 각각 C9804 및 C9806의 고유한 HCPCS 코드를 가지며, 지급 한도는 각각 $2,284.98까지입니다. CMS의 이 조치는 메디케어 수혜자들을 위한 보다 안전한 통증 관리 대안을 촉진하는 중요한 단계입니다.
Les Centers for Medicare and Medicaid Services (CMS) ont annoncé que la pompe d'infusion élastomérique ON-Q d'Avanos Medical et la pompe d'infusion électronique jetable ambIT recevront des paiements séparés de Medicare en vertu de la loi NOPAIN à partir du 1er janvier 2025. Cette décision, qui fait partie du système de paiement prospectif des hôpitaux pour patients externes (OPPS) et du système de paiement pour les centres chirurgicaux ambulatoires (ASC) de Medicare pour 2025, vise à améliorer l'accès à la gestion de la douleur non opioïdienne dans les environnements HOPD et ASC. La loi NOPAIN, valable jusqu'au 31 décembre 2027, prévoit un remboursement additionnel par Medicare pour les articles non opioïdes éligibles afin de réduire la dépendance aux opioïdes. Les pompes ON-Q et ambIT disposeront de codes HCPCS uniques (C9804 et C9806) et d'une limite de paiement allant jusqu'à 2 284,98 $ chacune. Cette initiative du CMS représente un pas important vers la promotion d'alternatives de gestion de la douleur plus sûres pour les bénéficiaires de Medicare.
Die Centers for Medicare and Medicaid Services (CMS) haben bekanntgegeben, dass die elastomerische Infusionspumpe ON-Q von Avanos Medical und die wegwerfbare elektronische Infusionspumpe ambIT ab dem 1. Januar 2025 separate Medicare-Zahlungen gemäß dem NOPAIN-Gesetz erhalten werden. Diese Entscheidung, Teil des Medicare Prospektiven Zahlungssystems für Krankenhaus-Außenpatienten (OPPS) und des Medicare Gebührenplans für ambulante chirurgische Zentren (ASC) für 2025, zielt darauf ab, den Zugang zu nicht-opioiden Schmerzmanagement in HOPD- und ASC-Umgebungen zu verbessern. Das NOPAIN-Gesetz, das bis zum 31. Dezember 2027 in Kraft ist, bietet zusätzliche Medicare-Erstattungen für qualifizierte nicht-opioide Produkte, um die Abhängigkeit von Opioiden zu verringern. Sowohl die ON-Q als auch die ambIT Pumpen werden über einzigartige HCPCS-Codes (C9804 und C9806) und eine Höchstgrenze für Zahlungen von bis zu 2.284,98 $ verfügen. Dieser Schritt der CMS ist ein bedeutender Fortschritt zur Förderung sichererer Schmerzmanagementalternativen für Medicare-Berechtigte.
- 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.
- None.
Insights
This CMS reimbursement decision represents a significant financial opportunity for Avanos Medical. With payment limitations set at
The 3-year program duration through 2027 provides a clear revenue visibility window. Being the first and only infusion pain pumps included under this policy gives Avanos a notable competitive advantage in the non-opioid pain management market. The unique HCPCS codes (C9804 and C9806) further strengthen the company's market position by streamlining the reimbursement process.
The NOPAIN Act implementation creates a substantial market expansion opportunity for Avanos's pain management portfolio. Having both flagship products qualify for reimbursement positions Avanos to capture a larger share of the
The separate reimbursement structure effectively positions these devices as cost-neutral alternatives for facilities, potentially accelerating the shift away from traditional opioid-based protocols. This could drive significant volume growth in the Medicare patient segment, which represents approximately
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
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,
*Registered Trademark or Trademark of Avanos Medical, Inc., or its affiliates. © 2018-2024 AVNS. All rights reserved.
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FAQ
When will Avanos Medical's ON-Q and ambIT infusion pumps receive separate Medicare payments?
What is the purpose of the NOPAIN Act mentioned in the PR?
What are the HCPCS codes for ON-Q and ambIT infusion pumps?
How much is the payment limit for ON-Q and ambIT infusion pumps under the new CMS rule?
Until when does the NOPAIN Act mandate separate payment for qualified non-opioid treatments?
