CMS Transitional Pass-through (TPT) Payment Category

CMS finalized its approval for TPT payment applicable to EXALT™ Model D Single-Use Duodenoscope, and has eliminated the device offset deduction providing hospitals with more appropriate payment for the single-use duodenoscope.

On December 2, 2020, Center for Medicare and Medicaid Services (CMS) finalized its approval of Boston Scientific’s application for TPT payment applicable to EXALT™ Model D Single-Use Duodenoscope.  In addition, we are pleased to share that as a direct result of Boston Scientific’s recent advocacy, CMS has eliminated the device offset deduction when calculating the TPT payment for single-use duodenoscopes. This change simplifies the TPT calculation and provides hospitals with more appropriate payment for the single-use duodenoscope. This change is retroactive to July 1, 2020 and will further support hospitals in providing patients with access to EXALT Model D.  

Earlier this year, CMS provided preliminary approval of Boston Scientific’s application for a TPT payment category to describe single-use endoscopes, including the EXALT™ Model D Single-Use Duodenoscope.  The new device TPT code (C1748) became effective July 1, 2020 and has been used successfully by hospitals to receive reimbursement up to the full cost of EXALT Model D when used to treat Medicare patients in the hospital outpatient setting. This device specific payment is in addition to the endoscopic retrograde cholangiopancreatography (ERCP) procedure payment. 

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): On October 16, 2020, Boston Scientific submitted an application for NTAP under Medicare’s Hospital Inpatient Prospective Payment System. If approved, this device specific payment would be applicable for single-use duodenoscopes when treating Medicare patients in the hospital inpatient setting for eligible inpatient admissions.  CMS will make a determination on the application in 2021.   
• Inpatient ICD-10-PCS Code:  Boston Scientific has submitted a request for the creation of a unique ICD-10-PCS code to support hospitals in reporting the use of EXALT Model D during ERCP procedures when performed in the hospital inpatient setting.  Boston Scientific presented this application at the September 8, 2020 ICD-10 Coordination and Maintenance Committee Meeting.  CMS will make a determination on the code in 2021. 

If you would like more information on the new changes to the TPT payment calculation and how this impacts EXALT Model D, please contact us at ENDOFRM@bsci.com or 508-683-4510.