The BD Aptra™ Ureteroscope Now Eligible for Reimbursement

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What does the New Transitional Pass-Through Device Payment Category Mean for BD Aptra™ Single-Use Digital Flexible Ureteroscope?
Calculate your estimated savings per case with the BD Aptra™ Single-Use Digital Flexible Ureteroscope
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Procedure to estimate partial reimbursement of the BD Aptra™ Ureteroscope for appropriate Medicare beneficiaries:


  • Estimated cost of a single-use ureteroscope:
    $1,350 Note 1
  • Less, estimated transitional pass-through payment:
    -$978 Note 2
  • Less, estimated avoided reprocessing cost per case:
    -$107 Note 3
  • Less, estimated avoided repair cost per case:
    -$441 Note 4
Net potential savings per case compared to reusable ureteroscopes:
TBD

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Effective January 1, 2023, a newly created Level II HCPCS Code (C1747) can be used to bill for BD Aptra™ Ureteroscope. This code is intended to be used for the actual device in hospital outpatient and ambulatory surgery center (ASC) settings for Medicare patients and may be billed in addition to the ureteroscopy procedure.
How to request reimbursement for procedures for Medicare patients using BD Aptra™ Single-Use Digital Flexible Ureteroscope and performed in a:

Hospital Outpatient Setting
Ambulatory Surgery Center (ASC)
Note 1: 
Please contact your BD Endourology Sales Specialist for exact pricing for your organization.
Note 2: 
Transitional pass-through payments are only applicable for appropriate Medicare Beneficiaries when the BD Aptra Single-Use Ureteroscope is bill under HCPCS code C1747.*
Note 3: 
Source for the $108 estimated cost of reprocessing: Taguchi K, Usawachintachit M, Tzou DT, et al. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes. J Endourol. 2018;32(4):267-273.
Note 4: 
Source for the $441 reusable flexible ureteroscope average repair cost per procedure is an 18-study meta-analysis (Source: Rindorf DK, Tailly T, Kamphuis GM, et al. Repair Rate and Associated Costs of Reusable Flexible Ureteroscopes: A Systematic Review and Meta-analysis. Eur Urol Open Sci . 2022;37:64-72.)

*
To calculate the transitional pass-through payment for the hospital setting, an estimated charge-to-cost ratio of 3.83 from an analysis of 532 hospitals’ total charge-to-cost ratio prior to private equity acquisition (Supp. Table 4) was employed. (Source: Bruch JD, Gondi S, Song Z. Changes in Hospital Income, Use, and Quality Associated with Private Equity Acquisition. JAMA Intern Med. 2020;180(11):1428-1435.) In addition, an estimated cost-to-charge ratio of 0.281, the national average CCR for FY 2023 for implantable devices, was employed. (Source: FY 2023 IPPS Final Rule (CMS-1771-F). Federal Register 87(153):48900-48902. August 10, 2022.) It is expected that hospitals would not seek a TPT payment for CPT code 50976.

Device Offset Amounts reference: www.cms.gov/files/document/r11737cp.pdf

Final CY 2023 APC Payment Rate reference: www.cms.gov/license/ama?file=/files/zip/2023-nfrm-opps-addenda.zip
The BD Aptra™ Ureteroscope offers:
  • Image quality enhanced with the light source inside the tip of the scope
  • Tapered 7.4 Fr. distal tip
  • Designed for maximum deflection to reach stones in the lower pole
The BD Aptra™ Single-Use Ureteroscope means a sterile scope for every case.

CONNECT WITH BD
For questions regarding reimbursement for the BD Aptra™ Single-Use Ureteroscope, please contact: [email protected].

The reimbursement information presented is for illustrative purposes only and does not constitute reimbursement or legal advice. The company does not guarantee that the use of any of the codes noted will ensure coverage or payment at any particular level. It is the provider’s sole responsibility to determine medical necessity and to in turn identify which codes to report and to submit accurate claims. Physicians and hospitals should confirm with a particular payer or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular procedure or combination of procedures. Reimbursement rules vary widely by insurer so the provider should understand and comply with any specific rules that may be set by a patient’s insurer, including the complex rules of Medicare and Medicaid. Under no circumstances will the company or its employees, consultants agents, or representatives be liable for costs, expenses, losses, claims, liabilities or other damages (whether direct, indirect, special, incidental, consequential or otherwise) that may arise from or be incurred in connection with this information or any use thereof. BD does not guarantee that the procedures described herein will be reimbursable in whole or in part, by any public or private payor, including Medicare. BD specifically excludes any representation or warranty relating to reimbursement. Please consult product labels and inserts for any indications, contraindications, hazards, warnings, precautions and instructions for use.

Intended use
BD Aptra™ Digital Endoscope System is intended to be used by physicians to access, visualize, and perform procedures in the urinary tract and the kidney. The instrument enables delivery and use of accessories such as biopsy forceps, laser fibers, graspers and retrieval baskets at a surgical site.

Contraindications
Diagnostic or therapeutic ureteroscopy is contraindicated in people with an untreated urinary tract infection. Other contraindications to therapeutic ureteroscopy (e.g. lithotripsy, endopyelotomy, tumor therapy) are more numerous and can mirror those associated with the corresponding open surgical interventions. Patients on anticoagulants or with coagulopathies should be managed appropriately.

Warnings
• Do not use electromedical energy sources in the presence of flammable detergents, anesthetics, nitrous oxide (N2O), or oxygen.
• Consult the user manuals of all electromedical energy sources used with endoscopic instruments for appropriate instruments, warnings and cautions prior to use. Such sources of energy include electrical, electrohydraulic, electrosurgical, heat hydraulic, laser, light, pressure, sound, ultrasound and vacuum.
• Do not insert or advance the ureteroscope unless there is a clear live endoscopic view of the lumen through which the scope is being advanced (or confirm with visualization by other imaging modalities).
• During the procedure, if the live endoscopic image is lost, do not advance or insert the ureteroscope and do not insert, advance or actuate accessories.
• Do not use excessive force while advancing or withdrawing the scope. If resistance is felt during advancement or withdrawal of the scope, investigate the source of resistance and/or take remedial action if necessary.
• Do not force the distal tip of the ureteroscope against the sidewall of the ureter or renal pelvis.
• Do not use excessive force when advancing or withdrawing an accessory within the ureteroscope.
• When inserting or using accessories, maintain continuous visualization of the distal tip. Ensure that the distance between the distal tip of the ureteroscope and the object in view is greater than the ureteroscope’s minimum visible distance. Failure to do so may result in the accessories causing patient injury.
• Do not withdraw a laser fiber back into the ureteroscope while the laser is firing. Doing so may cause patient injury and/or scope damage.
• Do not look directly into the light emitted from the ureteroscope.
• Verify ground isolation when setting up and using accessories from different manufacturers prior to procedure.
• Do not open the handle of the ureteroscope.
• The ureteroscope is a single-use device and there are no serviceable parts. Do not repair damaged or non-operating ureteroscopes. Do not use the ureteroscope if damage is discovered or suspected.
• Do not excessively bend the flexible shaft or the articulating section of the ureteroscope.
• If damage to the ureteroscope occurs or it stops functioning during a procedure, stop using the ureteroscope immediately. See troubleshooting section for more information. Continue the procedure with a new ureteroscope, as appropriate.


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