EXALT^TM Model D Single-Use Duodenoscope / Economics

A cost-effective alternative to reusable duodenoscopes

Model D can be an economically viable solution to reusable duodenoscopes when considering the hidden costs of reprocessing and separate device reimbursement for single-use duodenoscopes established by Medicare.  

Device Reimbursement

To ensure Medicare beneficiaries have access to single-use duodenscopes such as the EXALT Model D, the Centers for Medicare & Medicaid Services (CMS) approved Boston Scientific’s applications for a New Technology Add-on Payment (NTAP) and a Transitional pass-through (TPT) payment. 

With TPT and NTAP, Medicare cases can be eligible for device reimbursement, with Medicare cases representing over 40% of all ERCPs performed in the U.S. each year.¹

Email us to request a reimbursement guide to share with your hospital administration. 

New Technology Add-on Payment (NTAP)

Boston Scientific continues to lead the effort to secure appropriate coding and payment for EXALT Model D.

• Medicare Hospital Inpatient New Technology Add-on Payment (NTAP): The Centers for Medicare & Medicaid Services (CMS) has approved Boston Scientific’s application for new technology add-on payment applicable to EXALT Model D.  The intent of NTAP is to facilitate Medicare patient access to new and innovative devices, like EXALT Model D, by providing eligible cases with additional payment for the device over and above the MS-DRG payment for a Medicare hospital inpatient admission.  NTAP will be effective October 1, 2021.  
  
• Inpatient ICD-10-PCS Procedure Codes: In response to Boston Scientific's request, CMS created two unique ICD-10-PCS procedure codes for hospitals to facilitate reporting the use of single-use duodenoscopes, including EXALT Model D,  when used in the hospital inpatient setting beginning October 1, 2021.    

Transitional Pass-through Payment 

Learn how the CMS transitional pass-through (TPT) payment category for single-use scopes used in endoscopic retrograde cholangiopancreatography (ERCP) procedures provides device specific payment for hospitals.

Several hospitals have confirmed that the TPT payment has completely covered the hospital’s cost of EXALT Model D.  In addition, many hospitals across the country have confirmed that they are receiving payment from commercial payers for EXALT Model D.  Please note, this commercial payer coverage and payment is dependent on each individual hospital’s contractual agreement with its payers. Commercial payers are not required to follow CMS coverage; however, some may choose to do so.  It is recommended to reach out to commercial payers to understand commercial payer reimbursement for EXALT Model D.

The Hidden Costs of Reprocessing

Physician perspectives

Operational costs

The hidden costs of reprocessing

The basic reprocessing steps for reusable duodenoscopes steps include pre-cleaning, leak testing, manual cleaning, visual inspection, high-level disinfection and drying. But in practice, there can be more than 100 distinct steps that are labor-intensive and introduce the opportunity for contamination. With EXALT Model D Single-Use Duodenoscope, you can reduce the risk of infection due to reusable scope cross-contamination, increase efficiency and enable your staff to focus on other tasks.