The Centers for Medicare and Medicaid Services is set to issue a reimbursement rule as part of its final calendar year 2023 Outpatient Prospective Payment System (OPPS) that will increase Medicare payment for ultrasound-guided high-intensity focused ultrasound (HIFU) prostate tissue ablation.
The procedure has a current average reimbursement rate of $4,506. The new OPPS rule would significantly raise this rate, as it is set to increase Medicare reimbursement to $8,558 per procedure.
HIFU prostate tissue ablation utilizes focused ultrasound waves to treat diseased tissue. Compared to other prostate cancer treatments, such as radiation therapy and surgery, the procedure is quicker, much less invasive and lowers the risk of patients having to endure severe side effects that can accompany other treatments.
The clinical applications for focused ultrasound have continued to grow immensely for the last decade, while HIFU prostate tissue ablation has been in use for several years, with two systems receiving FDA approval for the procedure in 2015.
Industry Applause
The move by CMS to increase the procedure's reimbursement rates received praise from both the Medical Imaging & Technology Alliance (MITA) and the Focused Ultrasound Foundation.
Jessica Foley, PhD, the FUF’s chief scientific officer, indicated that the new rates could increase patient access.
“This ruling is especially exciting because it is something we have been advocating for with patients, doctors, manufacturers and MITA for some time,” Foley said in prepared remarks. “We know that focused ultrasound offers many benefits for patients, but we are also aware that in order for the treatment to become widely available, it needs to be profitable for hospitals. This ruling will ensure that this treatment option is a worthwhile investment for providers.”
Patrick Hope, executive director of MITA, echoed Foley’s sentiment, stating CMS “was right to support this minimally invasive treatment option that can effectively combat prostate cancer, reduce debilitating side effects, and lower downstream medical costs for patients.”
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.