RE: Observation11 Jan 2024 15:50
Establishing reimbursement coverage and payment
The new reimbursement APC-code (C9791) issued by the US Centers for Medicare & Medicaid Services ("CMS") in August 2023 for the XENOVIEW MRI technology corresponds to a payment range of between US$1,201 to US$1,300.
The new code, along with additional existing codes for the XENOVIEW MRI process, enables the hospitals to request a total reimbursement of approximately $2,500, representing a significantly improved economic incentive for the hospital. All seven United States Medicare Administrative Contractors (MACs), who are responsible for processing Medicare claims, are covering the code as of 1 October 2023 based on medical necessity.
Building on the new code from CMS, work is beginning at Polarean's clinical sites to further expand the reimbursement for private U.S. health insurers to enable further utilisation of XENOVIEW.