The Centers for Medicare and Medicaid Services (CMS) have established a new billing code for focused ultrasound ablation of prostate tissue that will go into effect on July 1, 2017. The announcement was made by both EDAP-TMS and SonaCare Medical, the two companies whose devices are approved in the US.
“For any novel technology, having insurance coverage is a very important part of enabling widespread availability,” says the Foundation’s Chief Medical Officer Tim Meakem, MD. “Medicare’s acceptance, which is likely to be followed by other commercial coverage, will make this care available to many more men in the US.”
The reimbursement strategy consulting firm Medical Technology Partners was instrumental in directing the reimbursement efforts. According to EDAP CEO Marc Oczachowski, the companies will continue to work with his team to pursue additional reimbursement for focused ultrasound procedures.
The new billing code (HCPCS code C9747) is specific to the ablation of prostate tissue using focused ultrasound under image guidance. C-codes are unique, temporary pricing codes initially established for the Hospital Outpatient Prospective Payment System (OPPS) and may also be recognized on claims from other providers or by other payment systems.
SonaCare Medical CEO, Mark Carol, MD, says "The issuance of this C-code represents a notable breakthrough for [focused ultrasound] in the United States, legitimizing the important role this technology plays in modern-day prostate care."
France-based EDAP-TMS markets Ablatherm for prostate tissue ablation in the US and for treatment of localized prostate cancer in the rest of the world.
SonaCare Medical is based in Charlotte, North Carolina and since FDA approval in 2015, Sonablate has treated more than 1,000 patients across more than 40 US locations.