Inspire Medical Systems, Inc. announced that the American Medical Association (AMA) CPT® Editorial Panel has approved the establishment of a new set of Current Procedural Terminology (CPT®) codes that accurately describe and include the Inspire V system. The new Category I codes are scheduled to take effect on January 1, 2028.
“This new CPT code language addresses the implantation of a single lead and an implantable pulse generator (IPG) including our recently launched Inspire V system,” said Tim Herbert, Chairman and Chief Executive Officer of Inspire Medical Systems. “We appreciate the AMA creating dedicated codes that will create a clearer, more consistent path for coding and reimbursement, which we expect will reduce administrative burden for hospitals and physicians and support continued growth in patient access to Inspire therapy. The application received broad society support with special thanks to the American Academy of Otolaryngology-Head and the Neck Surgery (AAO-HNS), the American Academy of Sleep Medicine (AASM) and the International Surgical Sleep Society (ISSS) for their support addressing the need to act now to provide a permanent coding solution for the Inspire V system and other single lead hypoglossal nerve stimulation IPG therapies.”
With the new codes created, the Centers for Medicare & Medicaid Services (CMS) will conduct its standard process to determine the value for each new CPT code, which determines the payments for that service under Medicare. CMS typically requests the AMA Relative Value Scale Update Committee (RUC) to review specific codes and evaluate whether physician time, work and expenses for related services have changed over time.
Specialty societies, such as the AAO-HNS, may survey their members and make recommendations to the RUC based on the output from the rigorous methodology for these surveys. These surveys would collect information regarding physician work including both time and complexity, practice expenses including clinical staff and any required supplies and equipment, and liability insurance. Sufficient physicians are surveyed to ensure accuracy of data collected.
After collecting and reviewing the data, the RUC recommendation is provided to CMS who we expect would publish their proposed valuation in July 2027 with final valuations published in November 2027.
The new Category I CPT codes reflect a growing body of clinical evidence supporting therapies like Inspire’s closed-loop implantable device, Inspire V, which is designed to work with a patient’s natural breathing to help keep the airway open during sleep. With more than 140,000 patients treated and over a decade of clinical experience, Inspire is a well-established leader in the treatment of OSA.
Source: Inspire Medical Systems
