Profound Medical Announces Category 1 CPT Codes Proposed CY2025 Rule for TULSA to Treat Prostate Diseases

Profound Medical Corp.
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Profound Medical Corp.
Profound Medical Corp.

TORONTO, July 11, 2024 (GLOBE NEWSWIRE) -- Profound Medical Corp. (NASDAQ:PROF; TSX:PRN) (“Profound” or the “Company”), a commercial-stage medical device company that develops and markets customizable, incision-free therapies for the ablation of diseased tissue, today announced that U.S. Centers for Medicare and Medicaid Services (CMS) has issued its proposed rules establishing, for the first time, a Category 1 CPT code for the Transurethral Ultrasound Ablation (“TULSA”) procedure, effective January 1, 2025.

According to the proposed rule, TULSA will have 3 physician codes to cover how therapy is delivered depending on if there are one or two physicians involved in the procedure: 5x006 TULSA Device Management and 5x007 TULSA Treatment, when two physicians are involved in the procedure, and 5x008 TULSA Complete Procedure, when performed by a single physician. TULSA will have a 0-day global period, indicating that the payment associated with the codes will only cover the work performed on the day TULSA is performed. Physicians will thereby bill for any pre or post patient visit separately using existing codes. This will provide physicians with the most flexibility to assess the appropriate number of visits needed by each patient and enable their safe and fast recovery. TULSA codes have also been assigned to all three sites of service: Hospital Outpatient (“HOPD”), Ambulatory Surgical Center (“ASC”), and Private Office/Non-Facility (“OBL”). The spectrum of the location of service will ensure patients can be treated in whatever setting they and their physician believe appropriate and convenient for each patient.

For Hospital Payment, the proposed rule has established TULSA as a Level 6 Urology Ambulatory Payment Classification (“APC”) for 2025 for 5x008 of $9,208.50 (National Average). For ASCs, the facility payment for 5x008 will be $7,195.00 (National Average).

The Proposed Rule for the Physician Fee Schedule has set the total Facility (HOPD or ASC) Relative Value Units (“RVU”) at 6.53 for TULSA Device Management 5x006 and 14.68 RVU for the TULSA Treatment Physician 5x007 when 2 physicians are involved in the TULSA procedure. If one physician performs the complete TULSA procedure, the RVU is 18.01 for 5x008.

The Proposed Rule for Physician fee schedule for Non-Facility (OBL or Private Office) has set RVU at 16.50 for TULSA Device Management 5x006 and 267.47 RVU for the TULSA Treatment Physician 5x007 when 2 physicians are involved in the TULSA procedure. If one physician performs the complete TULSA procedure, the RVU is 276.65 for 5x008.

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