AVERTIX MEDICAL ANNOUNCES FAVORABLE CHANGES TO CMS REIMBURSEMENT FOR THE GUARDIAN IN 2025

- Reimbursement changes expected to drive broader access and adoption of revolutionary heart attack detection system

-The Guardian has been assigned to APC 5224 with a Medicare national hospital outpatient rate of $19,071

-Multiple prestigious hospital systems have implemented The Guardian since its commercial launch in 2023

EATONTOWN, N.J., Nov. 11, 2024 /PRNewswire/ --Avertix Medical, Inc. ("Avertix" or the "Company"), the developer of The Guardian^® system - the world's first real-time, continuous heart attack detection and patient alerting system announced today that The Guardian System will conclude the three-year Medicare Transitional Pass-Through Payment (TPT) status at the end of this year. Effective January 1, 2025, under the Medicare Hospital Outpatient Prospective System, The Guardian will be fully reimbursed under APC 5224, with a national payment rate of $19,071. This transition marks a significant step in enabling broader access for patients across the U.S. and will provide appropriate reimbursement for providers delivering advanced heart attack detection capabilities to their high-risk cardiac patients.

"CMS's decision to map The Guardian System to APC 5224 is a major milestone. The Guardian System is the first and only real-time heart attack detection and alerting system designed to ensure patients who are at high risk have access to treatment quickly upon the onset of a heart attack.  CMS's appropriate APC assignment will provide hospitals and outpatient centers with streamlined billing and payment processes for The Guardian System," said Tim Moran, President and Chief Executive Officer of Avertix Medical. "This APC designation allows providers to deliver timely interventions for heart attacks in high-risk patients, helping protect more lives with innovative, real-time care."

Bundled Code Enhancements Support Broader Adoption

Kathy Francisco, CEO of The Pinnacle Health Group, emphasized the significance of the new APC reimbursement structure, stating, "The appropriate APC mapping by CMS, post TPT, ensures that hospitals can offer The Guardian System to their patients at reimbursement levels that appropriately cover the cost of care. We anticipate this change will eliminate financial barriers to adoption and allow patients access to this key breakthrough technology.

January 1, 2025, healthcare providers should continue to submit CPT code 0525T for the implantation of The Guardian System with HCPCS code C1833 as both codes will continue to be required on each claim.  Appropriate charges and costs for each code will ensure CMS correct APC assignment and payment values in the future." 

About The Guardian® System

The Guardian® System is implanted subcutaneously by cardiologists or electrophysiologists in a minimally invasive, outpatient procedure. Powered by a proprietary algorithm, The Guardian System continuously monitors the heart's electrical activity and alerts patients of ST segment changes associated with heart attacks. This technology provides an advanced layer of safety for patients who may not exhibit typical heart attack symptoms, promoting earlier intervention and improved outcomes.

About Avertix Medical, Inc.

Avertix Medical is a pioneering medical device company specializing in real-time, implantable heart attack detection technology. The company's flagship product, The Guardian® System, is FDA-approved and backed by a suite of U.S. patents, setting new standards in cardiovascular care. Avertix is committed to improving patient safety and outcomes with its innovative technologies. For more information, please visit www.avertix.com.

About Pinnacle Health Group

The Pinnacle Health Group partners with healthcare innovators to optimize their market presence and patient care reimbursement strategies. Pinnacle's services include targeted reimbursement and strategic support to maximize the acceptance of new technologies while receiving appropriate reimbursement. For more information, visit www.thepinnaclehealthgroup.com.

Disclaimer

Avertix Medical and The Pinnacle Health Group make no guarantee of coverage or payment by any payer. Providers are responsible for adhering to all CMS and private payer coding and billing guidelines.

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SOURCE Avertix Medical