Currently, the HEMOLUNG does not have a Medicare MS-DRG Assignment Code. It will be included as part of the following MS-DRGs until a new MS-DRG is created and assigned.
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT<=96 HOURS
The HEMOLUNG is indicated for respiratory support that provides extracorporeal carbon dioxide (CO2) removal from the patient’s blood for up to 5 days in adults with acute, reversible respiratory failure for whom ventilation of CO2 cannot be adequately or safely achieved using other available treatment options and continued clinical deterioration is expected.
This indication provides a means to assist in ventilator support as part of MS-DRGs 207 and 208. At this time, no additional reimbursement is available for the use of the HEMOLUNG.
New Technology Add-on Payment (NTAP) CMS Program
ALung has applied to a CMS Program called the New Technology Add-on Payment for FY2023. New Technology Add-On Payments, or NTAPs, allow for more appropriate reimbursement for new medical services and technology not yet included in Diagnosis Related Group (DRG) rates. CMS is scheduled to publish the proposed ruling in April 2022 with final publication in August 2022. There are three criteria that must be met:
- the medical service or technology must be new,
- the medical service or technology must be costly such that the DRG rate otherwise applicable to discharges involving the medical service or technology is determined to be inadequate, and
- the service or technology must demonstrate a substantial clinical improvement over existing services or technologies.
Should ALung receive an NTAP for HEMOLUNG use, hospitals will be able to receive this payment for HEMOLUNG use. Updates will be provided as the NTAP review proceeds.