MolecuLight has announced that the Centers for Medicare & Medicaid Services (CMS) has assigned an Ambulatory Payment Classification (APC) code 5722 for the MolecuLight i:X imaging procedure for point-of-care real-time fluorescence wound imaging for bacterial presence, location, and load.
The new APC code is effective 1 July, 2020 and enables facility reimbursement under the Medicare Hospital Outpatient Prospective Payment System (OPPS), with a 2020 hospital outpatient payment rate of approximately US$253.10. This is in addition to the two category III CPT codes (0598T and 0599T), which also become active on 1 July, 2020, that enable physicians to request payment from payers for their work providing the MolecuLight i:X imaging procedure.
According to a news release, the MolecuLight i:X is the world’s first and only portable imaging device that provides information about bacteria causing infection at the point-of-care, allowing physicians to better chart their course to heal wounds. Bacteria in wounds causes healing delays of weeks to months and results in costly patient visits and procedures. There are over six million procedures provided to wound care patients annually in the USA. With improved detection of the bacteria and information provided on bacterial location and load, the MolecuLight i:X-enabled procedure is positioned to facilitate improved wound care to millions of patients.
“The device provides essential diagnostic information at the point-of-care on the presence of bacteria in wounds that has dramatically improved our treatment planning and patient care. This information is vital to our wound clinicians for assessing, triaging, and monitoring wound patients and I see this technology as the future standard of care for wound treatment”, stated Alisha Oropallo, director of the Comprehensive Wound Healing and Hyperbaric Center, Northwell Health, New York, USA.
Of note, the company state that the new CPT procedure codes (0598T and 0599T) may be applied when using the MolecuLight i:X to identify bacteria in wounds at loads greater than 104 colony forming units (CFU) per gram. While coding and assignment to an APC enables reimbursement, each payer must decide on coverage based on the medical necessity of the patient encounter.