CMS has consolidated coverage of Intersect ENT's Sinuva sinus implant and published an average selling price for it.
CMS is consolidating all coding for Sinuva under code J7402, according to a March 8 news release. This incorporates Sinuva's "pass-through" status in ASCs with Medicare patients to code J7402 and eliminates a temporary sinus implant C-Code issued in July 2020. The changes are expected to clarify and simplify the coding process and improve accuracy in claims adjudication.
CMS also published an average selling price for Sinuva, creating predictability and transparency for reimbursement. In January 2021, CMS created separate codes for Sinuva's Propel and Sinuva lines.
"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," said Thomas West, president and CEO of Intersect ENT.