Boston Scientific Corporation (NYSE: BSX) announced that the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Medicare program, has acknowledged the substantial clinical improvement associated with the use of the Alair® Bronchial Thermoplasty System to perform bronchial thermoplasty for the management of severe asthma. As a result, effective January 1, 2012, the Alair catheter is eligible for Medicare reimbursement through a separate "pass-through" payment when the procedure is performed in an outpatient hospital setting. This pass-through payment will enable hospitals to receive payment for the Alair catheter in addition to Medicare's payment for the bronchial thermoplasty procedure until utilization and payment data are well established. The combined Medicare payments for the device and procedure should provide a strong benchmark for private insurers establishing reimbursement for bronchial thermoplasty.
"CMS' decision that the Alair Bronchial Thermoplasty System meets the criteria for transitional pass-through payment is a very positive development for severe asthmatics and the pulmonary physician community," said David Pierce, President of Boston Scientific's Endoscopy Division. "It supports what we have confirmed through our clinical trials: bronchial thermoplasty offers a new advancement in the treatment of patients with severe asthma who are not well controlled despite taking recommended doses of asthma medications. This decision also sets an important precedent for health care payers throughout the United States."
As of January 1, 2012, hospitals are able to report a special code for the Alair catheter along with one of two new Category III CPT® (current procedural terminology) codes established by the American Medical Association (AMA) for the bronchial thermoplasty procedure that will also be implemented for 2012. The new CPT codes will facilitate specific reporting of bronchial thermoplasty across all payers for the first time since the U.S. Food and Drug Administration (FDA) approved the Alair Bronchial Thermoplasty System for marketing in mid-2010.
"The AMA's creation of new Category III CPT® codes for bronchial thermoplasty represents a critical step toward consistent reimbursement for this ground-breaking procedure. The codes will simplify the process of submitting and adjudicating insurance claims for physicians and hospitals, as well as for asthma patients," said Parashar Patel, Vice President, Global Health Economics and Reimbursement for Boston Scientific. "The decision acknowledges the growing body of peer-reviewed, published clinical literature on bronchial thermoplasty's safety, efficacy and long-term health outcomes, and is the result of significant support from pulmonary specialty societies including the American Thoracic Society, the largest U.S.-based group representing more than 15,000 physicians, research scientists, nurses and other healthcare professionals."
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