ReWalk Robotics announced that the Centers for Medicare & Medicaid Services (CMS) has included the ReWalk Personal Prosthetic Exoskeleton system in the agenda for the upcoming Healthcare Common Procedure Coding System (HCPCS) meeting on November 29 and provided a preliminary payment determination of $94,617.
“The inclusion of the ReWalk Exoskeleton within the upcoming HCPCS agenda and the proposed preliminary pricing is a tremendous step forward in our efforts to ensure broader access to exoskeletons for the substantial percentage of the spinal cord injury community with Medicare coverage,” said CEO Larry Jasinski. “ReWalk is encouraged by the process used by CMS to determine its preliminary pricing, and by the statements from CMS that they are open to receiving updated information on pricing that reflects the breakthrough technological developments, including technology that enables ambulation on stairs and curbs, which have been implemented since ReWalk’s 2020 application. We look forward to continuing to work with CMS at the upcoming HCPCS meeting later this month.”
This news follows CMS’ previous determination that personal exoskeletons such as the ReWalk Personal Exoskeleton fall within the brace benefit category, which is reimbursed by Medicare on a lump sum basis. The preliminary payment determination was made by CMS through a gap filling process applied in light of CMS determining that lower-limb exoskeletons incorporate “revolutionary features” that cannot be described by any existing code or combination of codes.
As part of gap-filling, CMS utilizes verifiable supplier or commercial invoice pricing information and adjusts according to a deflation and update factor methodology. In applying this formula to the code describing the ReWalk Personal Exoskeleton, CMS relied on average prices from 2020 market transactions, which CMS determined to be $125,500, and resulted in preliminary Medicare pricing of $94,617.
CMS noted that it would welcome materials providing information on updated verifiable market transactions from ReWalk as well as any other makers of similar bilateral, lower-limb exoskeletons to “ensure that the Medicare payment amount for this code accurately reflects the full market of devices that would be classified in this code.”
A final payment determination is expected in early 2024 with an effective date of April 1, 2024.
