VisionCare Ophthalmic Technologies is mulling a CMS reimbursement proposal for its implantable miniature telescope, which is designed to improve vision in patients with end-stage age-related macular degeneration.
The California company disclosed that the Centers for Medicare and Medicaid Services proposes assigning the implant to a new ambulatory implant procedure code, where the mean cost would be calculated using available claims data. If all goes well, the reimbursement category would kick in on Jan. 1, 2014. For now, the company says it will analyze the proposal and submit comments to CMS as part of their ongoing rate-setting process. As part of that effort, VisionCare said it has shared data with CMS over the last year on both the cost and use of its FDA-approved device so far.
"We are encouraged by CMS' proposal to create a new clinical [ambulatory payment classification] for the telescope implant procedure … to solidify patient access," VisionCare CEO Allen Hill said in a statement.
It's not as if the telescope implant procedure hasn't had CMS coverage. It has, with reimbursement under a "transitional pass-through payment mechanism," but that expires on Dec. 31, 2013.
VisionCare bills its product as a "first-of-its-kind" telescope implant. But like most medical device and diagnostics companies with game-changing technology, they can't get very far at all without permanent CMS reimbursement. Government insurance coverage widens their market. But the CMS coverage, in turn, can open the door to private insurance coverage. Gaining both often guarantees a market for devices, procedures and tests that can be very expensive and otherwise unattainable on their own.
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