CMS Releases Final New Technology Add-on Payment Decisions

On August 2, 2021, CMS placed on display at the Federal Register the final fiscal year 2022 Inpatient Prospective Payment System Final rule. Amongst the over 2,000 pages are CMS's final decisions on New Technology Add-on Payments (NTAP) for FY 2022.

The NTAP program was designed to identify new technologies and to ensure that payment under the IPPS would be adequate so that early adopters of new technologies would not be financially disadvantaged. Under the traditional NTAP pathway, a technology must be considered "new", the charges of cases involving the technology must be more than 75 percent of the unadjusted rate for the MS-DRG to which the technology is assigned, and the technology must represent a substantial clinical improvement over existing technologies.

Beginning in 2021, CMS implemented an alternative NTAP pathway for technologies granted "break-through" approval by the FDA and for certain antimicrobial products. For this alternative pathway, technologies are assumed to meet both the "newness" criteria and the "substantial clinical improvement" criteria by the nature of their "break-through" approval status. These technologies must still meet the "cost" criteria.

CMS reviewed 26 NTAP applications under the traditional pathway. Nine were withdrawn by the applicant and one was not reviewed because the technology was not FDA approved by the deadline. CMS approved seven applications. Under the alternative pathway, CMS received 17 applications, reviewed 12, ultimately approving nine. These charts show the breakdown of the applications that CMS reviewed and of CMS's final payment determinations.

For more information about this rule, and about the NTAP process, contact me at john@policypros.net. The final FY 2022 rule is available for download here and will be published in the Federal Register on August 13, 2021.

John Warren is the owner and principal consultant at Gettysburg Healthcare Consulting. Located in Hanover, Pennsylvania. He focuses on issues affecting the Medicare program -- including coverage, coding, and reimbursement of diagnostic tests, prescription drugs and other Medicare covered services.

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