Vertos Medical Announces ASC Reimbursement Increase for the mild® Procedure
Source— Vertos MedicalDecember 8, 2020
ALISO VIEJO, Calif. — Vertos Medical Inc., a leader in the development of innovative, minimally invasive treatments for lumbar spinal stenosis (LSS), today announced that the Centers for Medicare and Medicaid Services (CMS) has increased Ambulatory Surgery Center (ASC) reimbursement for the mild® Procedure.
Effective January 1, 2021, the national average ASC reimbursement for CPT 0275T will increase by 41%, from $2,803.35 to $3,941.14, in recognition of the device cost associated with the procedure.
“The mild® Procedure is ideally suited for an ASC setting and we are pleased that CMS has improved the reimbursement for these facilities. We believe this will significantly increase patient access to the mild® Procedure across the country,” said Philip Macdonald, Vice President, Market Access & Reimbursement for Vertos Medical.
The mild® Procedure is a clinically proven outpatient LSS treatment that removes a major root cause of stenosis through a portal the size of a baby aspirin. It requires no implants, no general anesthesia, no stitches, no steroids or opioids and no overnight hospital stay.
The mild® Procedure is approved nationally for Medicare and Medicare Advantage patients and various regional private insurers. Coverage stands at over 80 million lives. Since the FDA clearance in 2006, the mild® Procedure has been performed on more than 30,000 patients and its safety and efficacy have been analyzed in 13 clinical studies and over 25 publications.
Benyamin, R., et al. (2016), mild® is an Effective Treatment for Lumbar Spinal Stenosis with Neurogenic Claudication: MiDAS ENCORE Randomized Controlled Trial, Pain Physician, 19: 229-242, ISSN 1533-3159.
Mekhail, Nagy, et al. (2012) Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 12(6): 417–425. doi: 10.1111/j.1533-2500.2012.00565.x.
2012 data from Health Market Sciences report for Vertos Medical 2013.
Data on file with Vertos Medical.
Staats PS, et al. for the MiDAS ENCORE Investigators. (2018), Long-term safety and efficacy of minimally invasive lumbar decompression procedure for the treatment of lumbar spinal stenosis with neurogenic claudication: 2-year results of MiDAS ENCORE. Reg Anesth Pain Med. 2018;43:789-794.
Based on mild® Procedure data collected in all clinical studies. Major complications are defined as dural tear and blood loss requiring transfusion.
MiDAS ENCORE responder data. On file with Vertos Medical.
Jain, S., et al. (2020), Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety, Pain Manag., Published online ahead of print: 1 Jul 2020, https://www.futuremedicine.com/doi/10.2217/pmt-2020-0037.
Deer, TR, Grider, JS, Pope, JE; For the Lumbar Spinal Stenosis Consensus Group. (2019) The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract. 2019;250-274. doi:10.1111/papr.12744
Hansson T, Suzuki N, Hebelka H, Gaulitz A. The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum. Eur Spine J. 2009;18(5):679-686. doi: 10.1007/s00586-
Treatment options shown are commonly offered once conservative therapies (e.g., physical therapy, pain medications, chiropractic) are not providing adequate relief. This is not intended to be a complete list of all treatments available. Doctors typically recommend treatments based on their safety profile, typically prioritizing low risk/less aggressive procedures before higher risk/more aggressive procedures, but will determine which treatments are appropriate for their patients.
Although the complication rate for the mild® Procedure is low, as with most surgical procedures, serious adverse events, some of which can be fatal, can occur, including heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood or fat that migrates to the lungs or heart). Other risks include infection and bleeding, spinal cord and nerve injury that can, in rare instances, cause paralysis. This procedure is not for everyone. Physicians should discuss potential risks with patients. For complete information regarding indications for use, warnings, precautions, and methods of use, please reference the devices’Instructions for Use.
Patient stories on this website reflect the results experienced by individuals who have undergone the mild® Procedure. Patients are not compensated for their testimonial. The mild® Procedure is intended to treat lumbar spinal stenosis (LSS) caused by ligamentum flavum hypertrophy. Although patients may experience relief from the procedure, individual results may vary. Individuals may have symptoms persist or evolve or other conditions that require ongoing medication or additional treatments. Please consult with your doctor to determine if this procedure is right for you.
Reimbursement, especially coding, is dynamic and changes every year. Laws and regulations involving reimbursement are also complex and change frequently. Providers are responsible for determining medical necessity and reporting the codes that accurately describe the work that is done and the products and procedures that are furnished to patients. For this reason, Vertos Medical strongly recommends that you consult with your payers, your specialty society, or the AMA CPT regarding coding, coverage and payment.
Vertos Medical cannot guarantee coding, coverage, or payment for products or procedures. View our Billing Guide.
Vertos is an equal employment opportunity workplace committed to pursuing and hiring a diverse workforce. We strive to grow our team with highly skilled people who share our culture and values. We do not discriminate on the basis of sex, age, color, race, religion, marital status, national origin, ancestry, sexual orientation, physical & mental disability, medical condition, genetic information, veteran status, or any other basis protected by federal, state or local law.