The payback tide may be turning for iRhythm


iRhythm has been navigating reimbursement turmoil since late January 2021, but updated rates released Monday morning by Medicare Administrative Contractor (MAC) Novitas appear to be a positive sign for the company.

After initially slashing the reimbursement rates for the CPT (current procedural terminology) codes that cover iRhythm Technologies’ Zio patch to around $ 43, from around $ 300 almost a year ago, Novitas increased the rates in April. at $ 103 and $ 115. iRhythm said at that time that it would stop providing its Zio XT (Zio Patch) service to Medicare’s fee-for-service segment if those rates remained unchanged. Then, in November, the Centers for Medicare and Medicaid Services (CMS) recommended a price of $ 200 for the patch, but opted not to finalize national pricing and instead maintained contractor prices for relevant CPT codes for the patch. 2022.

The new posted rates are set at $ 222 and $ 232 are retroactive to January 1, 2022. If the new rates had been in effect in 2021, this would have had a positive impact of approximately 10% on the company’s total revenues in 2021, iRhythm noted.

The technology from the San Francisco, Calif.-Based company combines portable biosensor devices worn for up to 14 days and cloud-based data analytics with algorithms that distill data from millions of heartbeats into clinically actionable information .

“We would like to thank Novitas and the other CAMs for their continued commitment and efforts to better understand long-term continuous ECG monitoring, the clinical benefits it offers to patients, and the costs and resources required to provide the service. The updated tariffs demonstrate progress in understanding the costs associated with providing the Zio service, ”said Quentin Blackford, who was appointed new CEO of iRhythm in September.

Blackford said the company will continue to work with MACs, CMSs and other stakeholders to provide information in support of what the company sees as fair and appropriate pricing.

“We are excited to have more clarity as we set our sights on 2022 and continue our quest to make Zio the standard of care for ambulatory heart monitoring. This positive news builds on the business momentum we experienced in the fourth quarter of 2021, where unit volumes slightly exceeded the company’s earlier expectations, ”said Blackford.

He added that the company would share full details of its fourth quarter and full year 2021 financial performance in its earnings call at the end of February.


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