- On June 8th, CMS published an update to the reimbursement calculation used to determine the transitional pass-through payment for the device category applicable to AUGMENT® Regenerative Solutions, which was originally implemented on January 1, 2020.
- Based on this update, when hindfoot and ankle fusions are performed in the outpatient setting (hospital outpatient and ASC), the facility will be paid for AUGMENT® separate from the payment for the ankle fusion procedure without offset.
- This change is made retroactive to January 1, 2020; claims that have been paid prior to June 8th will be adjusted retroactively to reflect the proper payment.
- This applies to beneficiaries enrolled in Medicare Part B under the traditional Medicare program (not Medicare Advantage beneficiaries or Commercially Insured patients).
- The pass-through payment will remain in place until Dec 31, 2022. By that time, CMS will have incorporated the cost data collected during the pass-through period (specifically the prior two years) to set the reimbursement rate for the applicable hindfoot and ankle fusion procedures for 2023 (and beyond).
*For additional AUGMENT® Reimbursement Support Tools and Information, visit www.wright.com/Reimbursement or contact us at Reimbursement@Wright.com.
To view the relevant information in the "July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)" see bottom of pg. 16 through pg. 17 of the document via this link: https://www.cms.gov/files/document/mm11814.pdf.