iRhythm Technologies is a bit disappointed with a recent decision from the Centers for Medicare and Medicaid Services.

The San Francisco, California-based company is challenging the final rule for the Medicare Physician Fee Schedule (MPFS) for the 2022 calendar year.

The final rule and accompanying addenda were released on November 2, 2021, along with updated payment policies, payment rates and other provisions for services provided under the MPFS on or after 1 January 2022.

iRhythm developed the Zio XT portable heart rate monitor.

CMS recommended a price of $ 200.15 for portable ECG patches. However, in the final rule, CMS did not issue national pricing and ongoing operator pricing for calendar year 2022 on Category I CPT codes 93241, 93243, 93245 and 93247 for extended external monitoring of the ECG, codes relevant to the company’s Zio XT service.

“While we are disappointed that national prices have not been included in the 2022 Physician Fee Schedule, we appreciate that CMS continues to engage with industry and other stakeholders to deepen their understanding of the components. cost of AI-based solutions such as iRhythm’s Zio service. We firmly believe that national pricing remains the best option for all stakeholders, ”said Quentin Blackford, President and CEO of iRhythm. “In the meantime, we will continue to work with MACs to provide insight into the 2022 calendar year pricing process and believe the final rule is potentially constructive in our conversations with MACs. We will share updates at the appropriate time.

Marie Thibault, analyst at BTIG, commented on the decision, going so far as to qualify it as a “new twist”.

“CMS is encouraging more comments and contributions to help determine national prices for the CY2023 cycle,” Thibault wrote in research notes. “This is a new turning point that we weren’t expecting (reimbursement always brings new surprises!) Had an impact on the agency’s decision-making, and there seems to be a fairly high probability of a national pricing decision for CY2023. While a price of $ 200 is not as high as iRhythm might have hoped, we believe it should be sufficient to enable a viable business model for the Medicare segment and, most importantly, limit significant rate cuts. by commercial payers in the future. “

The news comes just after Quentin Blackford was appointed President and CEO of iRhythm. Blackford is an experienced medtech executive who served as COO of Dexcom.