SAN CARLOS, Calif. -- Conceptus, Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has released the Final Rule for the 2005 Physician Fee Schedule, which provides for a national physician payment of $2,198.34 for Essure procedures performed in office. Physician payment for Essure procedures performed in hospitals has been set at $458.94. By comparison, tubal ligation, the current standard of care for female sterilization, has a national CMS 2005 physician procedure payment of $361.16. Commercial carriers may defer to these payment levels when negotiating their own physician fee schedules for the procedure, but it is expected that private payer values will be higher.
CMS also released its 2005 OPPS final rule, which assigns hospital outpatient amounts for procedures. CPT 58565 was assigned to APC 202 with a 2005 payment level of $2,260.37. This value is consistent with payments by CMS to hospitals when they are performing a laparoscopic tubal ligation, normally performed in a higher cost hospital operating room.
The new code is expected to facilitate physician billing and reimbursement for the Essure procedure, allowing greater patient access to this important advance in female sterilization. Specifically, given the 2005 payment levels for tubal ligation compared with those assigned to hysteroscopic sterilization, physicians may now choose the Essure procedure on the merits of its clinical benefits with less regard for the previous reimbursement disparities.
"This reimbursement value exceeds our expectations and is a major step along the road to establishing Essure as the standard of care for permanent female sterilization," commented Mark Sieczkarek, president and CEO of Conceptus. "Physicians tell us in our market research that reimbursement is the biggest hurdle to increased utilization of Essure and the availability of our CPT code and a favorable reimbursement is a definite step in removing that hurdle."
The Essure procedure deploys a soft micro-insert into the fallopian tube through the cervix using a minimally invasive transcervical tubal access catheter. Once in place, the device is designed to elicit tissue growth in and around the micro-insert to form an occlusion or blockage in the fallopian tube. An Essure procedure does not require cutting or penetrating the abdomen and can be performed in a less costly procedure setting without general anesthesia. A woman is able to return home about 45 minutes after the procedure is completed. There is a three-month waiting period after the procedure during which women must use another form of birth control. Essure is designed to be 99.80 percent effective after three years of follow-up.
Conceptus, Inc. manufactures and markets Essure, an innovative medical device and procedure, designed to provide a nonincisional alternative to tubal ligation, which is the leading form of birth control worldwide. The availability of Essure in the U.S. is expected to open up a market currently occupied by incisional tubal ligation and vasectomy, which combined account for over 1 million procedures annually.
Source: Conceptus, Inc.