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Is the New CMS Ruling a Win for iRhythm?

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Will this fee decision benefit the San Francisco, CA-based company in the long run?

iRhythm Technologies is a bit disappointed with a recent ruling from the Centers for Medicare and Medicaid Services.

The San Francisco, CA-based company is taking issue with Calendar Year 2022 Medicare Physician Fee Schedule (MPFS) Final Rule.

The Final Rule and accompanying Addenda were released on Nov. 2, 2021, along with updated payment policies, payment rates, and other provisions for services furnished under MPFS on or after Jan. 1, 2022.

iRhythm has developed the Zio XT wearable heart rhythm monitor.

CMS has recommended a price of $200.15 for wearable ECG patches. However, in the Final Rule, CMS did not issue national pricing and continued carrier pricing for calendar year 2022 on Category I CPT codes 93241, 93243, 93245, and 93247 for extended external ECG monitoring, the relevant codes for the company’s Zio XT service.  

“While we are disappointed that national pricing was not included in the 2022 physician fee schedule, we are appreciative that CMS continues to engage with industry and other stakeholders to further their understanding of the cost components of AI-based solutions such as iRhythm’s Zio service. We firmly believe that national pricing remains the best option for all stakeholders,” said Quentin Blackford, iRhythm President and CEO. “In the meantime, we will continue to work with the MACs to provide information for the Calendar Year 2022 rate setting process and believe the Final Rule is potentially constructive in our conversations with the MACs. We will share updates at the appropriate time.”

Marie Thibault, an analyst with BTIG, commented on the ruling going so far as to call it a “new twist.”

“CMS encourages more feedback and inputs to help determine national pricing for the CY2023 cycle,” Thibault wrote in research notes. “This is a new twist, and one we didn't expect (reimbursement always bring new surprises!) This final rule includes positive signs for iRhythm, including that $200 is significantly higher than the current contractor pricing, that the industry's efforts and invoice submissions had an impact on the agency's decision-making, and that there seems to be a fairly high likelihood of a national pricing decision for CY2023. While a $200 price is not as high as iRhythm might have hoped, we believe it should be enough to enable a viable business model for the Medicare segment and, importantly, limit major rate cuts by commercial payers in the future.”

The news comes hot on the heels of Quentin Blackford being appointed president and CEO of iRhythm. Blackford is an experienced medtech executive having served as COO of Dexcom.

 

 

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