Inspire Medical Systems, Inc. Provides Update on 2022 Ambulatory Surgical Center Reimbursement Levels

Rhea-AI Summary

Inspire Medical Systems (NYSE: INSP) announced updates to the 2022 reimbursement payment rates for procedures performed in Ambulatory Surgical Centers (ASCs). Effective January 1, 2022, the national average reimbursement for CPT code 64582, assigned for Inspire's hypoglossal nerve stimulation treatment, will be $24,828.64, with a device offset percentage of 88.07%. This update follows CMS's correction of a previously miscalculated device offset. CEO Tim Herbert expressed gratitude towards CMS for the prompt updates, providing clarity for ASCs and enabling them to schedule procedures without reimbursement uncertainties.

Positive

• Updated reimbursement rate for Inspire procedures in ASCs is $24,828.64, effective January 1, 2022.
• Device offset percentage corrected to 88.07%, enabling better financial planning for ASCs.
• CEO's positive remarks indicate strong communication with CMS, ensuring stability in scheduling procedures.

Negative

• None.

MINNEAPOLIS, Nov. 10, 2021 (GLOBE NEWSWIRE) -- Inspire Medical Systems, Inc. (NYSE: INSP) (“Inspire”), a medical technology company focused on the development and commercialization of innovative and minimally invasive solutions for patients with obstructive sleep apnea, is providing an update on the 2022 Reimbursement payment rates for Inspire procedures performed in Ambulatory Surgical Centers (ASCs).

The Centers for Medicare and Medicaid Services (CMS) today published updated addendum files for the 2022 ASC payment system, including updating the assigned device offset percentage and final payment rate for new CPT code 64582. This code was previously approved for closed-loop hypoglossal nerve stimulation by the AMA CPT Editorial Panel and is the new CPT code to report for Inspire procedures effective January 1, 2022.

CMS previously published the final OPPS/ASC rules including their statement accepting the Medicare Advisory Panel on Hospital Outpatient Payment (HOP Panel) recommendation to recalculate the ASC payment that was initially proposed in July 2021 to be approximately $17,000. CMS acknowledged that a default device offset of 31% was mistakenly used for the first calculation, and that claims data reported for CPT code 64568 should have been used instead, as this code is the current code to report for Inspire procedures.

While CMS published the OPPS/ASC final rules, they had not yet updated the addendum files, which provides the reimbursement levels for procedures performed in an ASC. Today, CMS updated the addendum files and the device offset percentage for CPT code 64582. The updated files reflect the national average reimbursement rate for CPT code 64582 of $24,828.64. This updated rate for an ASC is effective January 1, 2022. The final device offset percentage used in the addendum was 88.07%.

Tim Herbert, CEO of Inspire, stated, “We appreciate the responsiveness shown by CMS following the panel review and issuance of the OPPS rules. It was important for CMS to update the data tables as quickly as they did to allow ASCs to continue scheduling patients for Inspire therapy into 2022 without the uncertainty of the Medicare reimbursement rates. Physicians, hospitals and ASC now have a stable coding methodology and reimbursement clarity effective January 1, 2022.”

About Inspire Medical Systems
Inspire is a medical technology company focused on the development and commercialization of innovative and minimally invasive solutions for patients with obstructive sleep apnea. Inspire’s proprietary Inspire therapy is the first and only FDA-approved neurostimulation technology that provides a safe and effective treatment for moderate to severe obstructive sleep apnea.

For additional information about Inspire, please visit www.inspiresleep.com.

Forward Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical facts are forward-looking statements. Forward-looking statements involve inherent risks and uncertainties, and important factors could cause actual results to differ materially from those anticipated, including the factors identified under the captions “Risk Factors” and “Management's Discussion and Analysis of Financial Condition and Results of Operations” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2020 filed with the SEC, and as such factors may be updated from time to time in our other filings with the SEC, which are accessible on the SEC’s website at www.sec.gov and the Investors page of our website at www.inspiresleep.com. Forward-looking statements speak only as of the date they are made, and we undertake no obligation to update them in light of new information or future events.

Investor and Media Contact:
Bob Yedid
LifeSci Advisors
bob@lifesciadvisors.com
646-597-6989

FAQ

What are the new reimbursement rates for Inspire procedures in 2022?

The national average reimbursement rate for Inspire procedures (CPT code 64582) in ASCs is $24,828.64, effective January 1, 2022.

When will the updated payment rates for Inspire be effective?

The updated payment rates for Inspire procedures will be effective starting January 1, 2022.

What is the device offset percentage for Inspire's new CPT code?

The device offset percentage for the new CPT code 64582 is 88.07%.

How did CMS adjust the reimbursement rates for Inspire's procedures?

CMS adjusted the reimbursement rates following their acceptance of the Medicare Advisory Panel's recommendations on recalculated payment rates.

What is the significance of CPT code 64582 for Inspire?

CPT code 64582 is assigned for reporting Inspire's closed-loop hypoglossal nerve stimulation procedures, and it's effective from January 1, 2022.