Avanos Medical secures Medicare coverage for non-opioid pain pumps under the NOPAIN Act

On November 20, 2024By Littum

ALPHARETTA, Ga., November 11, 2024 /PRNewswire/ — Avanos Medical, Inc . (NYSE: AVNS) announced today that the Centers for Medicare and Medicaid Services (CMS) has issued its final Medicare Hospital Ambulatory Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ASC) Payment System Rule for 2025. This rule, which takes effect effective January 1, 2025, implements the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which mandates separate Medicare payment for qualifying non-opioid drugs and units.

The NOPAIN Act, enacted as part of the Consolidated Appropriations Act of 2023, aims to increase patient access to non-opioid drugs and devices used to manage pain in hospital outpatient (HOPD) and ASC settings by providing additional Medicare reimbursement for qualifying non-opioid items.

In the final rule, CMS confirmed that both Avanos ON-Q elastomer infusion pump and Avanos ambIT disposable electronic infusion pump non-opioid pain management delivery systems meet qualifying requirements, marking a significant milestone as both become eligible for separate payment for the first time under NOPAIN- the law. HOPDs and ASCs using these products will receive separate Medicare reimbursement in addition to the related APC payments beginning January 1, 2025.

Both ON-Q and ambIT infusion delivery systems each received a unique, brand-specific Healthcare Common Procedure Coding System (HCPCS) code that is eligible for separate payment in the HOPD and ASC settings. This decision by CMS is a critical step toward improving access to clinically proven non-opioid therapies for Medicare beneficiaries in HOPD and ASC settings.

The payment limit calculated and published by CMS is up to $2,284.98 for the ON-Q infusion system and up to $2,284.98 for the ambIT infusion system. The new unique HCPCS code C9804 for ON-Q and HCPCS code C9806 for ambIT can be used on claim submissions beginning for services provided on January 1, 2025.

The NOPAIN Act mandates that CMS provide separate payment for qualified non-opioid treatments through December 31, 2027, when they are provided by a covered surgical procedure. The ON-Q and ambIT units are now the first and only infusion pain pumps included under this policy, which aims to reduce the reliance on opioids in post-operative care. CMS will review and approve eligible products on an annual basis during this 3-year program. This initiative is part of a broader strategy by CMS to combat the opioid crisis by promoting safer pain management alternatives.

Michael Greiner, Avanos Medical’s interim CEO, praised the CMS decision, saying, “The inclusion of ON-Q and ambiIT pumps under the NOPAIN Act is a testament to the devices’ effectiveness in reducing opioid use after surgery. We commend CMS for their commitment to improving patient access to non-opioid treatments, and we are dedicated to working with healthcare professionals to advocate for evidence-based non-opioid treatments.”

ON-Q elastomers and ambIT electronic infusion pumps have been validated by CMS as a treatment that can effectively replace or reduce postoperative opioid use, as proven by clinical trials and peer-reviewed data. These innovative devices deliver continuous local anesthesia, providing patients with targeted pain relief while minimizing opioid consumption.

For more information about ON-Q and ambiIT coverage under the NOPAIN Act, please click here: Avanos NOPAIN Act.

For inquiries regarding the NOPAIN Act, contact our Market Access and Reimbursement team at [email protected].

To view the final rule in its entirety, visit Federal register.

About Avanos Medical
Avanos Medical (NYSE: AVNS) is a medical technology company focused on delivering clinically superior medical device solutions that will help patients get back to the things that matter. Headquartered in Alpharetta, GeorgiaAvanos is committed to meeting some of today’s most important healthcare needs, including providing a vital lifeline of nutrition for patients from hospital to home and reducing the use of opioids while helping patients transition from surgery to recovery. Avanos develops, manufactures and markets its recognized brands globally and has leading market positions in several product categories. For more information, visit www.avanos.com and follow Avanos Medical on X (@AvanosMedical), LinkedIn and Facebook.

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