Helius Medical announces CMS reimbursement payment determination

Helius Medical Technologies announced that the Centers for Medicare & Medicaid Services – CMS – posted final Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies fee schedule payment rates for the PoNS Mouthpiece at $2,963.30 to be implemented January 1, 2025 and deferred final national determination of the payment rate for the PoNS Controller to the next payment cycle. CMS has corrected the reimbursement for the PoNS Mouthpiece as an essential accessory for which payment is made on a lump sum basis, as opposed to the preliminary determination of making monthly rental payments. The methodology used for setting the price remained the gap filling approach. As also published on October 7, 2024, CMS elected to defer final determination of reimbursement for the PoNS Controller until the next payment cycle due to “more time needed to evaluate this complex issue.” Subsequently, on October 8, 2024, CMS published the preliminary rate of reimbursement for the PoNS Controller at the capped total payment of $519.80, based on its view that the product is comparable to devices reported with HCPCS code E0730. This preliminary decision will be discussed at the HCPCS public meeting on November 8, 2024.