SINUVA® Sinus Implant Reimbursement Picture Clears

Sinuva sinus implant

ENT technology company Intersect ENT®, Inc., has announced that the U.S. Centers for Medicare and Medicaid Services (CMS) have published an average selling price (ASP) for the Company’s SINUVA® sinus implant.

Background

We’ve covered Intersect ENT’s progress before, most recently in January 2021 when the company’s Propel® implant gained CMS coding. See that piece here.

SINUVA is a non-surgical, corticosteroid-eluting implant for the treatment of nasal polyps in adult patients who have had ethmoid sinus surgery.

CMS has now attached an ASP to J7402, “mometasone furoate sinus implant, (sinuva), 10 micrograms.” Previously, a single code covered both products despite their substantial differences. The company expects that this move will provide predictability, transparency, and confidence of reimbursement for providers and payers.

Additionally, CMS confirmed consolidation of all coding for SINUVA into the newly created Code, J7402. In so doing, CMS’s action incorporates SINUVA “pass-through” status in ambulatory care settings with Medicare patients to the new J-Code, J7402, and eliminates the temporary sinus implant C-Code, C9122, issued in July 2020. These actions came as a result of the Company’s application to CMS for clarification and simplification in coding of the products. The Company believes the separate and dedicated codes will have a positive impact on patient and physician access by improving accuracy in claims adjudication, supporting expanded use at multiple sites of service, and providing greater clarity of coverage for payers and providers.

Company comments

“We are pleased that CMS consolidated SINUVA coverage to a single code and published a SINUVA ASP. These actions will help better inform ENT surgeons of the amount of implant reimbursement they can expect regardless of setting of care, thereby greatly reducing the uncertainty that can come with claims submissions,” stated Thomas A. West, President and Chief Executive Officer of Intersect ENT.

“CMS’s recent decisions will also clearly differentiate coding for SINUVA and PROPEL, two very different products. This will serve to simplify and streamline coding and reimbursement across our portfolio and will support evidence-based and cost-effective care across the continuum of need in chronic rhinosinusitis.”

Read full release here.

Source: Businesswire

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