iRhythm® Technologies Comments on the Proposed Medicare Physician Fee Schedule Released by the Centers for Medicare and Medicaid Services for Calendar Year 2023
SAN FRANCISCO, July 08, 2022 (GLOBE NEWSWIRE) — iRhythm Technologies, Inc. (NASDAQ:IRTC), a leading digital healthcare solutions company focused on the advancement of cardiac care, today provided comment on the recently released Centers for Medicare and Medicaid Services (“CMS”) Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2023 (the “Proposed Rule”). The Proposed Rule was released on July 7, 2022 and proposes to update the payment rates and other provisions for services furnished on or after January 1, 2023 and reimbursed under the Medicare Physician Fee Schedule (“MPFS”). The Proposed Rule is followed by a public comment period which will culminate with CMS’ release of a Final Rule, which is expected to be announced by early November for implementation on January 1, 2023. The policies announced in the Proposed Rule are therefore subject to change.
The Proposed Rule, with the accompanying addenda, include proposed payment rates for two Category I Current Procedural Terminology (“CPT”) code sets related to long term continuous electrocardiogram (“ECG”) monitoring and recording that iRhythm uses to seek reimbursement for its Zio® XT service. Category I CPT codes 93241 through 93248 are split between two sets of four codes with rates tied to those codes for (i) wear-time of greater than 48 hours and up to 7 days, and (ii) greater than 7 days up to 15 days. iRhythm primarily relies on CPT codes 93247 (for wear-time of greater than 7 days and up to 15 days) and 93243 (for wear-time of greater than 48 hours and up to 7 days) to seek reimbursement for its Zio XT service.
In the Proposed Rule, CMS proposed relative value units (“RVUs”) for CPT codes 93247 and 93243 and a Calendar Year (“CY”) 2023 Conversion Factor that, collectively with the Medicare payment reduction (sequestration) and the sequestration under the statutory Pay-As-You-Go, may imply national payment rates of $215 and $204 for CPT codes 93247 and 93243 codes, respectively. Based on the proposed CY 2023 Geographic Practice Cost Index (“GPCI”) modifiers applicable to the locations of the Company’s Medicare-enrolled Independent Diagnostic Testing Facilities (“IDTFs”) in Chicago, IL, Houston, TX and San Francisco, CA, iRhythm estimates the applicable payment rates could range from $218 to $295 for CPT code 93247 and $207 to $280 for CPT code 93243. Using the Proposed Rule’s implied rates and based on the Company’s current expectations for volume mix across its IDTF locations in CY 2023, iRhythm initially estimated that if the proposed CY 2023 rates had been implemented for CY 2022, the impact to its revenues would have been immaterial to its current full-year 2022 revenue guidance.
“We appreciate CMS’s evaluation of the cost inputs they have been provided and for their continued focus on establishing National rates for long-term continuous ECG monitoring,” said Quentin Blackford, iRhythm’s President and CEO. “We will continue to engage with CMS during the open comment period to share relevant information in support of the rule-making process, in anticipation of the release of the Final Rule. Meanwhile, we remain focused on continuing the important work of delivering our Zio XT service to the millions of patients who need it.”
About iRhythm Technologies, Inc.
iRhythm is a leading digital healthcare company redefining the way cardiac arrhythmias are clinically diagnosed. The company combines wearable biosensor devices worn for up to 14 days and cloud-based data analytics with powerful proprietary algorithms that distill data from millions of heartbeats into clinically actionable information. The company believes improvements in arrhythmia detection and characterization have the potential to change the clinical management of patients.
Forward-Looking Statements
This news release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934 and the Private Securities Litigation Reform Act of 1995. These statements include statements relating to the potential Medicare reimbursement rates for the CPT codes primarily relied upon for the Company’s Zio XT services, and current expectations on the volume of services that may be performed at its IDTF locations in calendar year 2023. Such statements are based on management’s current assumptions that involve risks and uncertainties, and actual outcomes and results could differ materially from those anticipated. The risks and uncertainties that may cause actual results to differ materially from current expectations, many of which are beyond our control, include risks more fully described in iRhythm’s Quarterly Report on Form 10-Q for the period ended March 31, 2022, as filed with the Securities and Exchange Commission on May 6, 2022. These forward-looking statements speak only as of the date hereof and should not be unduly relied upon. Except as required by law, iRhythm assumes no obligation to update any such forward-looking statement after the date of this release.
Investor Relations Contact
Stephanie Zhadkevich
(919) 452-5430
stephanie.zhadkevich@irhythmtech.com
iRhythm Media Contact
Morgan Mathis
(310) 528-6306
irhythm@highwirepr.com
