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Osseochondral Knee Implant

ADVI analyzed the reimbursement environment for a novel osseochondral implant under development to determine whether existing codes and payment would be sufficient for the new device. The team evaluated pros and cons of positioning the product as another allograft and whether obtaining a new code would be required.  Payment for allograft products under the Medicare hospital outpatient prospective payment system was studied to understand whether a new technology APC or transitional pass-through payment would be warranted and the potential role of FDA Breakthrough status. ADVI also interviewed Medicare and commercial medical directors to determine current perceptions of product positioning and use, and assessed the opportunity for growth, and the likely requirements for coverage (clinical trials, etc.) in other indications not yet targeted by the client.