SUNNYVALE, Calif., Nov. 3 /PRNewswire-FirstCall/ -- Kyphon Inc. today announced that the Centers for Medicare & Medicaid Services (CMS) posted the Final Rule for the Medicare Physician Fee Schedule for calendar year 2006, including three new Category I CPT (Current Procedural Terminology) codes for kyphoplasty procedures and their associated relative value units. In addition, the CPT radiologic codes were revised to include kyphoplasty (vertebral augmentation) procedures.
Beginning January 1, 2006, the following CPT codes will be effective for physician reimbursement for kyphoplasty:
CPT Code Description 2006 RVUs Unadjusted Payment* 22523 Percutaneous vertebral augmentation, including cavity creation (fracture reduction including biopsy when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g. kyphoplasty); thoracic 16.29 $589.32 22524 Percutaneous vertebral augmentation, including cavity creation (fracture reduction including biopsy when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g. kyphoplasty); lumbar 15.61 $564.72 22525 Each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) 7.47 $270.24 76012 Radiologic supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance 1.88 $68.01 76013 Radiologic supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under CT guidance 1.93 $69.82
The 2006 physician fee schedule incorporates a 4.4 percent reduction in payment for all physician services, which is reflected in the conversion factor ($36.1770) and all payment rates.
"This represents a major milestone in kyphoplasty's evolution as a mainstream surgical therapy in the treatment of vertebral compression fractures and reflects CMS' and the American Medical Association's CPT Editorial Panel's views that kyphoplasty is appropriate for national coding recognition," said Richard Mott, president and chief executive officer of Kyphon. "The new CPT codes were established based on the scientific evidence of kyphoplasty, and we are very pleased that the procedure has achieved this degree of stature within the national healthcare reimbursement system."
Using the newly published fee schedule, the adjusted Medicare payment to physicians for their professional services is expected to range from approximately $565 to $778 for a single-level kyphoplasty procedure with fluoroscopy and approximately $872-1,175 for a two-level kyphoplasty procedure with fluoroscopy. These ranges reflect that Medicare payment rates are adjusted to account for geographic variations in practice expenses and malpractice insurance costs.
Until these national reimbursement codes go into effect on January 1, 2006, physicians will continue to be reimbursed at the local level in all 50 states for performing kyphoplasty procedures either under established policies using the unlisted CPT code 22899, or in those states where no policy exists, on a case-by-case basis. Local reimbursement currently ranges between approximately $500 and $1,000 for a single-level kyphoplasty, with a very few outlier geographic regions both below and above this range.
"We believe establishment of these national CPT codes will significantly streamline the reimbursement claims submission process for clinicians performing the kyphoplasty procedure by allowing electronic filing of claims, eliminating the need to prepare and provide back-up documentation as is often currently required in many states, and achieving consistency across the country," concluded Mott.
For more information regarding the reimbursement process for the kyphoplasty procedure, including a list of frequently asked questions (FAQs), please visit http://kyph.client.shareholder.com/ .
The 2006 Final Rule for the Physician Fee Schedule can be found at http://www.cms.hhs.gov/physicians/pfs/ .
About Kyphon Inc.
Kyphon develops and markets medical devices designed to restore spinal function using minimally invasive technologies. The company's KyphX line of products are used in Balloon Kyphoplasty, a minimally invasive procedure to treat spinal fractures caused by osteoporosis or cancer. For more information, visit Kyphon's Web site at http://www.kyphon.com .
NOTE: Kyphon and KyphX are registered trademarks of Kyphon Inc.
This press release contains forward-looking statements within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. Forward looking statements include, but are not limited to, those that use words such as "believes," "expects," "anticipates," "targets," "intends," "plans," "projects," and words of similar effect, and specifically include the company's future financial projections and anticipated business direction and performance. Forward-looking statements are based on management's current preliminary expectations and are subject to risks, uncertainties and assumptions, which may cause the company's actual results to differ materially from the statements contained herein. Information on potential risk factors that could affect Kyphon, its business and its financial results are detailed in the company's periodic filings with the Securities and Exchange Commission (SEC), including, but not limited to, those risks and uncertainties listed in the section entitled "Management's Discussion and Analysis of Financial Condition and Results of Operations -- Factors Affecting Future Operating Results," which can be found in Kyphon's quarterly report on Form 10-Q for the quarter ended September 30, 2005, filed with the SEC on November 2, 2005 and in Kyphon's annual report on Form 10-K for the year ended December 31, 2004 filed with the SEC on March 2, 2005. Kyphon undertakes no obligation to release publicly any revisions to any forward-looking statements contained herein to reflect events or circumstances after the date hereof.
*Unadjusted payment = RVUs x $36.1770 (2006 conversion factor). Actual payment may differ. To calculate adjusted payment, the RVUs for physician work, practice expense and professional liability are multiplied by a geographic practice cost index, added together, and then multiplied by the conversion factor.
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Kyphon Inc.CONTACT: Julie D. Tracy, Vice President, Investor Relations and CorporateMarketing of Kyphon Inc., +1-408-548-6500, or jtracy@kyphon.com
Web site: http://www.kyphon.com/
