Key Points
- The US Centers for Medicare and Medicaid Services has proposed a rule that – if approved – would increase the reimbursement that treatment sites receive for performing focused ultrasound for the prostate.
- Two HIFU manufacturers – EDAP and Sonablate Corp. – publicly support the proposed rule.
- The comment period closes in September, and the Foundation encourages those in the field to voice their support.
The US Centers for Medicare and Medicaid Services (CMS) recently released its proposed outpatient prospective payment system (OPPS) reimbursement rule for 2023. The new rule would increase the reimbursement level of an outpatient high-intensity focused ultrasound (HIFU) prostate treatment to an Ambulatory Payment Classification (APC) level 6. It is currently at APC level 5. If accepted, the rule would increase the reimbursement that treatment sites receive for performing HIFU for the prostate.
“If the preliminary rule is in fact approved, it will be a big win for HIFU ablation of the prostate in the US,” says Foundation Senior Consultant Mark Carol, MD. “Reimbursement is a huge hurdle for the success of any new treatment because if the rate is too low and a hospital ultimately loses money each time they perform a HIFU treatment, there is a high likelihood they will not offer the treatment to patients who could benefit from it. The new rule would raise the level of reimbursement to the point where it becomes financially competitive with the other prostate therapies, allowing patients to realize the same disease control as achieved with standard treatments but with the much lower incidence of life-altering side effects characteristic of HIFU ablation.”
Dr. Carol recently wrote a blog post on the cost comparison of focused ultrasound to other standard-of-care treatments and released the Foundation’s open-access tool designed to help with determining the cost of care.
Two prominent HIFU manufacturers – EDAP and Sonablate Corp. – publicly support the proposed rule.
Read EDAP’S Press Release >
Read Sonablate Corp.’s Press Release >
What’s next?
Comments on the proposed rule are due by September 13, and the Foundation encourages those in the field to voice their support.
The final rule will likely be issued November, and the policies and payment rates in the final rule are anticipated to take effect January 1, 2023.