iRhythm: CMS Declines New Pricing for ECG Monitoring, Maintains Status Quo Pricing

Published on Dec 01, 2020

The Center for Medicare and Medicaid Studies has declined to approve a new, higher reimbursement rate for electrocardiographic monitoring, according to the 2021 Physician Fee Schedule published today.

Instead, CMS is retaining the de facto pricing for ECG monitoring negotiated between Medicare Administrative Contractors and healthcare providers while it studies the issue further and searches for additional data on which to set a new price.

The decision is negative for iRhythm Technologies (IRTC), which dominates the ECG monitoring space. Earlier this year, CMS had proposed a rate of $375.83 and $386.16 for 1 week and 2 weeks’ worth of monitoring, respectively. However, several comments on CMS’ proposed price pointed out several deficiencies in its methodology that that they claimed would result in overpayment for ECG monitoring.

In its final rule today, CMS appears to have sided with those commenters, saying “given the conflicting information and assertions provided by commenters, we are unable to identify accurate national pricing for the ‘extended external ECG patch, medical magnetic tape recorder’ (SD339) supply. To allow additional time to receive more pricing information, we are finalizing contractor pricing for CY 2021 for the four codes that include this supply input… We welcome the submission of additional invoices or other pricing information to assist us to determine the most accurate values for these services.”

iRhythm did not immediately respond to a request for comment.