CMS approves CardioMEMS, MitraClip for add-on payments

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 - healthcare cost

The Centers for Medicare & Medicaid Services (CMS) agreed to provide some reimbursement for the CardioMEMS heart failure and MitraClip valve devices beginning in fiscal year 2015.

In its coverage decisions for 2015, CMS approved New Technology Add-On payments for the two devices. The reimbursement pathway was designed to facilitate the use of innovative technologies by providing some reimbursement to cover the costs of the research and development of breakthrough technologies.

Hospitals that implant the CardioMEMS HF System will receive “an incremental amount” in addition to their Medicare reimbursement under their Medicare Severity Diagnosis Related Group payment, St. Jude Medical announced. CardioMEMS received FDA approval on May 28 after being rebuffed in 2011.

MitraClip is a catheter-based minimally invasive device that is designed to treat patients with mitral regurgitation who are considered too high risk for surgery. The device, which is manufactured by Abbott, won FDA approval on Oct. 24, 2013.

Cardiologists had warned CMS that without some reimbursement for the $30,000 valve device, hospitals may choose not to offer the treatment because they might incur financial losses.  

The add-on provision will take effect Oct. 1.