30 Day Trial

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Year in Review

TranS1 Coverage Update

As reported in ORTHOFLASH 1/11, Humana will now include coverage for medically necessary interbody fusion (IBF) procedures that employ TranS1's pre-sacral AxiaLIF approach, at the same reimbursement level as other IBF surgeries for which Humana provides coverage. Humana serves ~10MM medical members. Following notes were culled from the company’s conference call update.

* TranS1’s reimbursement strategy comprises obtaining positive coverage decisions from payors and graduating the Category III CPT T code to a Category I CPT code for AxiaLIF
* Currently working closely with Humana on proper coding of T code to ensure efficient processing of physician reimbursement; engaged in discussions with other payors, currently focused primarily on mid-sized regional payers
* Primary targets represent ~25MM-30MM covered lives, and list is growing
* One factor in initial focus on mid-tier payors is to allow time for body of clinical publications to grow, as papers progress through peer review
*As more papers publish and more positive coverage momentum is gained, will expand target list beyond regions with favorable customer profile and focus actively on larger national payors
* Hopes to graduate to Category I code on 1/1/13; to do so, needs successful outcome from AMA CPT meetings in 6/11, 10/11 or 2/12 (based on current pipeline of publications, targeting 10/11 meeting)
* Two papers represent largest body of evidence with AxiaLIF: one 154-patient retrospective, 2-year follow-up, other 9,100 patient review of adverse events and complications with pre-sacral approach; these stand out as necessary to ensure a successful AMA CPT meeting to graduate the Category III code