ON-Q* Elastomeric Infusion Pump and ambIT* Disposable Electronic Infusion Pump to Receive Separate Payment Under NOPAIN Act Starting January 1, 2025
The NOPAIN Act, passed as part of the Consolidated Appropriation Act of 2023, aims to increase patient access to non-opioid drugs and devices used to manage pain in Hospital Outpatient (HOPD) and ASC settings by providing additional Medicare reimbursement for qualifying non-opioid items.
In the final rule, CMS confirmed that both the Avanos ON-Q elastomeric infusion pump and the Avanos ambIT disposable electronic infusion pump non-opioid pain management delivery systems meet qualifying requirements, marking a significant milestone as both become eligible for separate payment for the first time under the NOPAIN Act. HOPDs and ASCs that use these products will receive separate Medicare reimbursement in addition to the related APC payments beginning
Both ON-Q and ambIT infusion delivery systems each received a unique, brand-specific Healthcare Common Procedure Coding System (HCPCS) code eligible for separate payment in the HOPD and ASC settings. This decision by CMS is a pivotal step towards enhancing access to clinically proven non-opioid treatments for Medicare beneficiaries in HOPD and ASC settings.
The payment limitation calculated and published by CMS is up to $2,284.98 for the ON-Q infusion system and up to $2,284.98 for the ambIT infusion system. The new unique HCPCS code C9804 for ON-Q and HCPCS code C9806 for ambIT can be used on claim submissions beginning for services rendered on
The NOPAIN Act mandates that CMS provide separate payment for qualified non-opioid treatments through
The ON-Q elastomeric and ambIT electronic infusion pumps have been validated by CMS as a treatment that can effectively replace or reduce postoperative opioid use, as proven by clinical trials and peer-reviewed data. These innovative devices continuously deliver local anesthetic, providing patients with targeted pain relief while minimizing opioid consumption.
For more information on ON-Q and ambIT coverage under the NOPAIN Act, please click here: Avanos NOPAIN Act.
For inquiries regarding the NOPAIN Act, contact our Market Access and Reimbursement Team at reimbursement@avanos.com.
To view the final rule in its entirety, visit the
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