Benzinga | Jan 19, 2021 07:06AM EST

Intersect ENT Announces CMS Approval Of Coding Application For PROPEL Sinus Implant

Approval Establishes New S Code for PROPEL to Facilitate Specific Coding & Payment

Intersect ENT(r), Inc. (NASDAQ:XENT), a global ear, nose and throat ("ENT") medical technology leader dedicated to transforming patient care, today announced that the Centers for Medicare and Medicaid Services (CMS) have approved a revised coding application filed by the Company for its family of PROPEL (mometasone furoate) sinus implants used to reduce inflammation and maintain patency following sinus surgery. Prior to this decision, PROPEL shared a billing code with the Company's related but therapeutically distinct SINUVA(r) (mometasone furoate) sinus implant, used to reduce polyps and the need for revision sinus surgery. The approval of this new application establishes a separate code for PROPEL, S1091 "Stent, non-coronary, temporary, with delivery system (propel)," as well as updates the current SINUVA J-Code to, J7402 "Mometasone furoate sinus implant, (sinuva), 10 micrograms." The Company believes these specific coding assignments, will have a positive impact by improving the accuracy in claims adjudication for both PROPEL and SINUVA, support expanded use in multiple sites of service for both products, provide greater clarity for payers and providers and solidify the current reimbursement environment. CMS will discontinue the original shared Level II HCPCS code J7401 "Mometasone furoate sinus implant, 10 micrograms." The new PROPEL and SINUVA codes are scheduled to take effect April 1, 2021.

"We are pleased that CMS recognized the benefit to payers and providers of decoupling the previously shared, and therefore potentially confusing, single J-Code for both SINUVA and PROPEL. These are distinct offerings with different uses and benefits. In addition, SINUVA is classified by FDA as a drug and PROPEL as a device. With the dedicated and updated SINUVA code, J7402, and a specific PROPEL code, S1091, payers can now more accurately delineate and reimburse based upon the specific use of each product. Moreover, Payers can accurately align each product's National Drug Code (NDC) to the product-specific, CMS-assigned, code and the product's actual use," said Thomas A. West, President and Chief Executive Officer of Intersect ENT. "CMS's agreement, at our request, to assign separate codes to SINUVA and PROPEL reflects and supports our deliberate strategy to leverage Intersect ENT's proprietary drug eluting sinus stent technology platform while, at the same time, broadening our portfolio of therapeutic offerings, clinical indications and health economic data to support evidence-based and cost-effective care across the continuum of need in chronic rhinosinusitis."