Ultromics Receives HOPPS Code for EchoGo Heart Failure in Outpatient Setting Following Inpatient Reimbursement Earlier this Year
11-9-23 (by: Scott Gleason) Ultromics has announced that the Centers for Medicare & Medicaid Services (CMS) has revised the assignment of the clinical ambulatory payment classification (APC) for the Healthcare Common Procedure Coding System (HCPCS) code C9786, designating it to APC 5743 with a payment rate of $284.88, effective January 1, 2024. This initiation of Medicare payment for hospital outpatient departments is poised to offer improved reimbursement for healthcare facilities incorporating the new technology. The change is expected to facilitate wider adoption within hospital outpatient settings, building on the recently approved CMS technology add-on payment (NTAP) for reimbursement in the hospital inpatient setting, effective from October 1, 2023. Under this change EchoGo Heart Failure is eligible for reimbursement up to $1,023.75 per acute hospital inpatient stay.
EchoGo Heart Failure, an artificial intelligence-powered device specializing in the analysis of minimally invasive echocardiogram scans and integrates an AI decision support algorithm for detecting heart failure with preserved ejection fraction. Previous algorithms used to detect heart failure missed up to 75% of patients and the technology received FDA approval in December 2022 after receiving breakthrough device designation.
Dr. Ross Upton, CEO and Founder of Ultromics, emphasized the significance of this milestone, stating that it empowers hospitals to expedite the integration of EchoGo® Heart Failure into their workflow. This, in turn, enhances HFpEF detection within healthcare systems, addressing an underdiagnosed condition. With approximately 50% of non-invasive cardiac imaging tests performed in office-based settings, this reimbursement decision holds exciting potential for expanding the adoption of Ultromics’ technology.