Medicare to pay in full for PAD drug-coated balloons

The Centers for Medicare & Medicaid Services (CMS) has agreed to fully reimburse the cost of drug-coated balloons for outpatient treatment of Medicare patients with peripheral artery disease, retroactive to April 1, 2015.

CMS changed reimbursement to cover additional costs to hospitals for patients treated with the two drug-coated balloons that currently are FDA approved for use in the superficial femoral artery and the popliteal artery: Bard’s Lutonix device and Medtronic’s IN.PACT Admiral device.

In February of 2015, CMS approved supplemental reimbursement for the two drug-coated balloons under Medicare’s outpatient prospective payment system. In its most recent review, the agency decided to improve the pass-through payment for drug-coated balloons by removing the device offset charge, according to Bard.

CMS will reimburse the full cost of drug-coated balloons for PAD procedures, Bard announced, retroactive to April 1. The reimbursement determination does not apply to inpatient procedures.