Inspire V Payment & Coverage Quick Take

By John Leppard Published on January 13, 2025 PDF

INSP’s disclosure today that physicians will likely be billing its Inspire V device procedures under CPT 64568 ($596) during a “transition period” – rather than existing Inspire IV code CPT 64582 ($816), as we had thought possible – has several implications, in our view.

A graph of blue rectangular bars Description automatically generated with medium confidence
  • The numerically 27% lower payment rate appears to be only partially mitigated by Inspire V’s 20% shorter procedure time, with the per-minute rate still 9% lower than Inspire IV at the median.
  • This would likely need to be made up for with improved case volumes per day.
  • Since the $596 code is not currently listed under Medicare coverage policies, these will likely need to be updated to avoid prior authorization hurdles for physicians.
  • Such an update risks eroding INSP’s competitive moat if future devices (e.g., LIVN’s Aura6000) target that same billing code, as we would expect.
  • This coding does not bring any change in facility reimbursement, with Medicare CY25 hospital outpatient rates set at $30,474 for both CPT 64568 and CPT 64582.
  • With INSP also suggesting that it will seek revisions to existing code CPT 64582 to better describe the Inspire V device, as we have suspected, it is unlikely that this could be made effective prior to 2027.
  • At that point, however, we would expect physician payment rates to exceed the $596 level under CPT 64568, with our base case for an updated CPT 64582 being ~$750, relative to today’s $816.

A screenshot of a medical report Description automatically generated

A table with numbers and a few different colored numbers Description automatically generated with medium confidence