iRhythm also prced at PALMETTO

 Of interest - MolDx began newly putting prices on its DEX website.  Notoriously, Novitas a few weeks before put on its website local prices for iRhythm (at a huge discount to the longstanding and just-prior local price).    Here, Palmetto puts iRhythm prices on its website.   I've seen where FCSO is putting Cat III or other local prices on ITS website.    

Is there a CMS push behind this, or is it magically all happening by concidence?

 

###### iRhythm (IRTC):  Palmetto Rate Read-Through

John Leppard, 202-756-7703 jleppard@washingtonanalysis.com

The move by Medicare Administrative Contractor (MAC) Palmetto last night to establish global payments of $160 for the 2-7 day wear time code for electrocardiographic (ECG) monitoring [CPT 93241], while positive relative to Novitas payment levels, provides us with an incrementally negative read-through for iRhythm (IRTC), and to a lesser extent Hill-Rom (HRC) and Boston Scientific (BSX).   Although Palmetto has yet to set rates for the scanning & analysis portion of the service [CPT 93243], nor the 7-15 day wear global [CPT 93245] / scanning & analysis [CPT 93247] components, both of which are more material for these companies: 1) a $160 global rate would imply Palmetto payments of ~$122 for IRTC’s scanning / analysis portion [explanation below], in line with our long-held base case;  2) this is likely a setback for hopes that payments might return to pre-2021 levels [$311], even in the unlikely event Palmetto [0.83% of legacy volumes] ascribes a 2x+ multiplier to 7-15 day rates; and  3) the already questionable prospect of companies funneling volumes through alternative MACs, should Novitas [97.74% of legacy volumes] not adjust its current rates upward [$43], now has more negligible upside.  We continue to believe that Novitas is likely to revise its Jan. 29 reimbursement, likely within the next few weeks, but would view a best-case scenario as ~$170. For our full thoughts on the matter, please click here.