Photocure ASA., (OSE: PHO), announces that The United States Centers for Medicare & Medicaid Services (CMS) has released final payment rates in connection with the recently approved Medicare reimbursement changes for Blue Light Cystoscopy (BLC®) with Cysview® in the hospital outpatient (HOPD) and ambulatory surgical center (ASC) sites of care. The new complexity adjustments and resulting increase in payment provide an opportunity to increase BLC usage in outpatient bladder cancer surveillance procedures.
Link to the CMS Rule: https://www.cms.gov/files/document/cy2023-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-final-rule.pdf
CMS confirmed that a complexity adjustment will be available for procedures billed under CPT Code 52000, as well as CPT Code 52204 which were subject to the adjustment in 2022. The two procedures, if also billed with the A9589 Code for Cysview® and the C9738 Code for the complexity adjustment, will have higher reimbursement beginning January 1, 2023.
In the HOPD setting, CMS for the first time has made a complexity adjustment for CPT 52000 (cystoscopy) and will maintain the current adjustment for CPT 52204 (cystoscopy + biopsy). The new Medicare reimbursement changes increase payment from $587.56 to $1,854.88 for CPT 52000 (cystoscopy) and from $3,140.04 to $3,205.12 for CPT 52204 (cystoscopy + biopsy) in the HOPD site of care.
Additionally, CMS for the first time has made a complexity adjustment available for ASC sites of care for both CPT 52000 and CPT 52204. To facilitate this, CMS has created two new complexity adjustment C codes for BLC to be used in the ASC place of service (C7554 with CPT 52000 and C7550 with CPT 52204). The changes will increase payment beginning in January 2023 from $297.97 to $848.03 for CPT 52000 and from $816.76 to $1,496.56 for CPT 52204.
“The effectiveness and benefits of using Blue Light Cystoscopy with Cysview for improved detection and management of bladder cancer are widely recognized, and Photocure has long advocated that CMS provide appropriate reimbursement for BLC treatment” said Dan Schneider, President and Chief Executive Officer of Photocure ASA. “We are pleased that CMS has expanded the complexity adjustment for Cysview in the hospital outpatient setting and will implement a complexity adjustment for the first time in the ASC site of care. The improved reimbursement is expected to increase patient access to blue light cystoscopy in the surveillance setting.”
Hexvix®/Cysview® and BLC® are registered trademarks of Photocure ASA.
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