CAESAREA, Israel (December 11, 2020)—Itamar Medical Ltd., a medical device and digital health company focused on the integration of sleep apnea management into the cardiac patient care pathway, commented on the recent release of the 2021 Physician Fee Schedule from the U.S. Centers for Medicare & Medicaid Services (CMS). This Fee Schedule represents the third year of a four-year proposed plan to reevaluate reimbursement in home sleep apnea diagnostic codes. The final changes will become effective on Jan.1, 2021.
The 2021 Fee Schedule further widens the gap between the CPT-95800 used with Itamar Medical’s WatchPATTM device of approximately $163, a 3.5% decrease from 2020, compared to CPT-code 95806 used with competitive Home Sleep Apnea Testing (HSAT) devices of approximately $95, a 20% decrease from 2020.
In the 2021 Fee Schedule, the professional RVUs of both 95800 and 95806 were slightly increased (about 1%), but for the first time in the last three years of adjustments, have CPT-95800 Technical Component RVUs increased by 9.5% while CPT-95806 technical RVUs were significantly reduced (18.8%). In addition to the RVUs, the rates were further impacted by the broader reduction in the CMS conversion factor from 36.09 to 32.41 resulting in the final fee schedule rates.
“The increase in 95800 RVUs will allow providers utilizing our WatchPAT devices to maintain the current reimbursement levels despite the broader reduction in conversion rates, allowing them to continue to diagnose their patients and improve lives,” said Gilad Glick, CEO of Itamar Medical. “The changes to the 2021 Physician Fee Schedule for code 95800 continue the steady trend we have seen since 2017, and we expect to see continued support, thereby expanding the broad use of the WatchPAT device.”
For more information about the CMS update, click here.
A 2021 Reimbursement and Coding Guide can be also found on the Itamar Medical here.
