The Centers for Medicare and Medicaid Services (CMS) has established a national payment rate for RefleXion Medical's Scintix biology-guided radiotherapy system.
CMS used its New Technology Ambulatory Payment Classification pathway to establish the payment rate. This is reserved for novel procedures that are not represented in the existing reimbursement claims data that describes new procedures and their associated resources. It determines whether a technology is actually new.
RefleXion said while other technologies use anatomical images to guide radiotherapy delivery, Scintix therapy is the only radiotherapy to use emissions from cancer cells. These are created by injecting the patient with a radiopharmaceutical to deliver a radiation dose that targets the cancer itself.
CMS created two new reimbursement codes for use in the hospital outpatient setting, effective January 1, to describe Scintix therapy. The first code, C9794, defines a separate pre-treatment procedure in which radiopharmaceutical emissions data is collected for use in creating the treatment delivery plan. The second code, C9795, is for delivery of the treatment plan and is billed after each treatment session.
RefleXion said the new codes and payment are expected to facilitate clinical adoption of the company's novel cancer treatment option.
