08/12/2024
Increased Payment Rates for Minimally Invasive Endoscopic Procedures to Treat Swallowing Disorders
Effective January 1, CMS increased the hospital outpatient payment rate for POEM procedures (CPT code 43497) by 67%, from approximately $3,261 to $5,435. The higher payment rate reflects the complexity and resources of this time-consuming procedure.
“We are pleased to see positive payment updates for POEM procedures following a rigorous evidence-based review by CMS,” said Carolyn Miller, M.D., M.P.H., M.S., M.S., M.P.H ... ”
POEM is an endoluminal, minimally invasive alternative to open or laparoscopic surgery to treat swallowing disorders such as achalasia. Achalasia is an esophageal disorder in which the lower esophageal sphincter does not relax properly, preventing food and liquids from passing into the stomach.
POEM is an alternative to Heller myotomy, a laparoscopic procedure for achalasia. A common nonsurgical treatment option is pneumatic dilation, where a balloon is inserted into the esophageal sphincter and inflated to widen the opening. If the esophageal sphincter fails to stay open, the procedure may need to be repeated, and about one-third of patients who undergo the procedure require re-treatment within five years.
Studies examining the effectiveness of POEM have found the procedure to be safe and effective, with a 90% clinical success rate over five years, and significantly higher clinical success rates at 12, 24, and 36 months for POEM compared to pneumatic dilation
“We applaud CMS’ decision to better align POEM payment rates with the complexity of the procedure. We hope this will allow more patients access to procedures that may improve patient outcomes," said Craig Munroe, MD, Global GI-ET Medical Affairs Director, Advancing minimally invasive procedures such as POEM. As part of our commitment to being patient-centric, we will continue to work to increase awareness of options like these."
