4DMedical lung scan procedure to be included in US reimbursement program
Respiratory imaging technology company 4DMedical (ASX: 4DX) has confirmed that its XV LVAS procedure is to be included in a key medical treatment reimbursement program in the United States.
From 1 January 2024, XV LVAS scans conducted in a US hospital outpatient facility for Medicare patients will be able to be billed to the US Centers for Medicare & Medicaid Services (CMS).
XV LVAS refers to ‘X-ray Velocimetry Lung Ventilation Analysis Software’. It is a new technology that uses an x-ray machine to take a series of x-rays of the chest. The x-ray images are then converted into detailed, 4-dimensional (3D in motion) images of a patient’s lungs.
These images are used by a doctor to understand how the patient’s lungs move and function when breathing.
Respiratory conditions account for a large proportion of healthcare spending in the US, with total medical expenditure in the treatment of all respiratory diseases estimated at around $267 billion.
Benchmark payment breakthrough
4DMedical managing director and chief executive officer Andreas Fouras said XV LVAS now has a benchmark payment level for hospital outpatient procedures, providing a guide for private health insurers in determining their pricing levels.
“I am very excited by this progress in the commercialisation of our technology, and the positive impact this reimbursement decision will have upon doctors and their patients,” Mr Fouras said.
“Achieving a Medicare reimbursement of $470 per scan is a major milestone in our progress to secure reimbursement across the entire US healthcare system and meaningfully removes a barrier to broader adoption across the large network of facilities providing healthcare to the 65 million Americans enrolled in Medicare.”
“This ruling will lead to accelerated uptake of XV LVAS, which in turn will support our pursuit of a Category I Current Procedural Terminology (CPT) code.”
Federal assistance helping offset costs
CMS is the US federal agency providing health coverage through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace.
Medicare is a particularly important public health insurance scheme for US adults aged 65 years and over, with some 65.7 million people enrolled in the program as of 1 March 2023.
CMS has various payment methodologies and fee schedules applicable to procedures, services, and products based upon where services are rendered.
In 2022, 4DMedical successfully established a new and distinct AMA Category III CPT code identifying the use of XV LVAS by healthcare providers and payers.
Category III CPT codes are a set of temporary codes for new and emerging technologies that are created for data collection in substantiating the widespread usage of a technology.
CMS has now included the assignment of payment levels to the CPT III codes for XV LVAS in the 2024 Hospital Outpatient Prospective Payment System Proposed Rule.
Widened access to XV LVAS
Mr Fouras said the positive review and consideration of information and public comment provided by 4DMedical led to CMS accepting the reimbursement request and finalised the assignment of the Category III CPT code for XV LVAS at the rate of $470 per scan.
CMS payment policy changes affect care delivery at more than 4,000 Medicare-certified hospitals across the US.
For 4DMedical, this significant and positive change ensures that XV LVAS is available to Medicare patients afflicted with lung disease and offers a funding source for providers of the technology beyond full out-of-pocket payment.