November 29, 2025
DXCM, TNDM, BBNX, RMD, COLOB.DC, CTEC.LN: Competitive Bidding Comes for CGM, Pumps, & More
With CMS finalizing [Fact Sheet, Final Rule] its intention to include continuous glucose monitors (CGM) [DXCM, ABT], insulin pumps [TNDM, BBNX], and urological / ostomy supplies [COLOB.DC, CTEC.LN] in the next round of the Competitive…
November 25, 2025
[DXCM, ABT] CGM Report Suggest Competitive Bidding Coming
Publication of the HHS Office of Inspector General’s (OIG) long-awaited report today on Medicare payments for continuous glucose monitors (CGM): (A) bolsters our long-held view that the agency intends to finalize its intention to include…
November 22, 2025
INSP, NYXH, LIVN: Surprise (But Short Lived?) Payment Win
CMS’s surprise decision to reassign cranial nerve neurostimulator code CPT 64568 to a $45K New Tech APC (+48% YoY) represents a significant 2026 tailwind for both vagus (VNS) [LIVN’s Sentiva] and hypoglossal nerve stimulation (HNS)…
November 18, 2025
IRTC Coverage Risks: Smoke or Fire?
With shares of IRTC pressured yesterday amid speculation on the risks associated with a Sept. 25 draft local coverage determination (LCD), we suspect the final version – likely released in March / April – will…
November 14, 2025
MMSI: Wrapsody Outpatient Margin Implications
Consistent with our long-held expectations [here, here], MMSI’s disclosure yesterday that CMS has “deferred” a decision on its Wrapsody transitional pass-through (TPT) payment application suggests a greater likelihood that it was denied, in our view,…
November 13, 2025
GKOS: iDose Medicare Coverage Expectations
Yesterday’s Medicare Administrative Contractor (MAC) advisory committee (CAC) meeting on GKOS’s iDose bolsters our relatively sanguine outlook going into the event [here, here], and would expect any headwinds from a likely mid-2026 draft local coverage…
November 3, 2025
[MDXG, CTEC.LN, COLOB.C] Skin Substitute Rates & Additional Risks
Consistent with our expectations, we view MDXG and CTEC.LN as most exposed to CMS’s finalized Physician Fee Schedule (PFS) policy to reduce skin substitute payments from current Average Sales Price (ASP) / invoice levels to…
November 3, 2025
PRCT: Nominal Rates vs Opportunity Costs
CMS’s final CY26 Physician Fee Schedule (PFS) released late Friday will reduce payments for PRCT Aquablation services by -29% in 2026, going from a volume-weighted $765 across the seven Medicare Administrative Contractors (MACs) to $542,…
October 31, 2025
Merit Medical (MMSI): Net vs List Price in Pass-Through Payments
We remain skeptical of MMSI’s prospects for a Wrapsody Medicare hospital outpatient transitional pass-through (TPT) payment following company confirmation last night that its application relies on an $8K list price, rather than the $5.8K net…
October 29, 2025
[MDT, Otsuka] Renal Denervation: Broad Coverage, With New Guardrails
We view CMS’s final coverage policy for renal denervation (RDN) [Medtronic (MDT), Otsuka (4578.JT)] as largely consistent with the initial proposal, but with some modest new guardrails that may incrementally slow utilization and delay /…