Avanos notes CMS final Medicare Hospital OPPS, Medicare ASC Payment System rule

Avanos (AVNS) Medical announced that the Centers for Medicare and Medicaid Services has issued its final Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center Payment System rule for 2025. This rule, effective Jan. 1, 2025, implements the Non-Opioids Prevent Addiction in the Nation Act that mandates separate Medicare payment for qualifying non-opioid drugs and devices. The NOPAIN Act, passed as part of the Consolidated Appropriation Act of 2023, aims to increase patient access to non-opioid drugs and devices used to manage pain in Hospital Outpatient and ASC settings by providing additional Medicare reimbursement for qualifying non-opioid items. In the final rule, CMS confirmed that both the Avanos ON-Q elastomeric infusion pump and the Avanos ambIT disposable electronic infusion pump non-opioid pain management delivery systems meet qualifying requirements, marking a significant milestone as both become eligible for separate payment for the first time under the NOPAIN Act. HOPDs and ASCs that use these products will receive separate Medicare reimbursement in addition to the related APC payments beginning January 1, 2025. Both ON-Q and ambIT infusion delivery systems each received a unique, brand-specific Healthcare Common Procedure Coding System code eligible for separate payment in the HOPD and ASC settings. This decision by CMS is a pivotal step towards enhancing access to clinically proven non-opioid treatments for Medicare beneficiaries in HOPD and ASC settings. The payment limitation calculated and published by CMS is up to $2,284.98 for the ON-Q infusion system and up to $2,284.98 for the ambIT infusion system. The new unique HCPCS code C9804 for ON-Q and HCPCS code C9806 for ambIT can be used on claim submissions beginning for services rendered on January 1, 2025. The NOPAIN Act mandates that CMS provide separate payment for qualified non-opioid treatments through December 31, 2027 when provided with a covered surgical procedure. The ON-Q and ambIT devices are now the first and only infusion pain pumps included under this policy, which aims to reduce reliance on opioids in postoperative care. CMS will review and approve eligible products on an annual basis during this 3-year program.