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 released its final rule (the
“Final Rule”) establishing, for the first time, a Category 1 CPT®
code for the Transurethral Ultrasound Ablation (“TULSA”) procedure,
effective January 1, 2025.
According to the Final Rule, TULSA will have
three codes to cover how therapy is delivered depending on if there
are one or two physicians involved in the procedure: CPT 51721
TULSA Device Management and CPT 55881 TULSA Treatment, when two
physicians are involved in the procedure, and CPT 55882 TULSA
Complete Procedure, when performed by a single physician. All three
TULSA codes 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-procedure patient visits separately using
existing evaluation and management (E/M) 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.
Uniquely for prostate treatment modalities,
TULSA codes have 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 TULSA patients can be treated in an
unrivalled number of settings.
For Hospital Payment, the Final Rule has
established TULSA CPT 55882 as a Level 7 Urology Ambulatory Payment
Classification (“APC”) for 2025 of $12,992 (Medicare National
Average). For ASCs, the facility payment for CPT 55882 will be
$10,728 (Medicare National Average). This represents increases of
approximately 41% and 49% for hospitals and ASCs, respectively,
over TULSA payments previously set in the Proposed Rule announced
in July 2024 and is also 25% higher than the Final Rule for robotic
radical proctectomy, a mainstream treatment modality for prostate
cancer, and 41% higher than the 2025 payment classification for
benign prostatic hyperplasia (“BPH”) treatments, such as
Aquablation.
“We are delighted to see that CMS recognized the
value proposition of the TULSA procedure and placed it in Urology
APC Level 7. The codes will be applicable in the widest possible
range of treatment settings, including hospitals and ASC’s, imaging
centers, and office settings, such as large urology practices.
Clinically, TULSA is being used today at leading hospitals
primarily for whole- and partial-gland treatment of a variety of
prostate cancer grades and/or as relief from symptoms of BPH in
certain patients who would otherwise need surgical interventions.
We are pleased to bring to market an innovative procedure like
TULSA that completely changes patient care from major surgery that
can cause significant side effects to incision-free intervention
with no blood loss, no hospital stay and preservation of patients’
vital functions,” said Arun Menawat, Profound’s CEO and
Chairman.
The Final Rule for the Physician Fee Schedule
has set the total Facility (HOPD or ASC) Relative Value Units
(“RVU”) at 6.47 for CPT 51721 TULSA Device Management and 14.56 RVU
for CPT 55881 TULSA Treatment, when 2 physicians are involved in
the TULSA procedure. If one physician performs the complete TULSA
procedure, the RVU is 17.91 for CPT 55882.
The Proposed Rule for Physician fee schedule for
Non-Facility (OBL or Private Office) has set RVU at 16.25 for CPT
51721 TULSA Device Management and 263.05 RVU for CPT 55881 TULSA
Treatment, when 2 physicians are involved in the TULSA procedure.
If one physician performs the complete TULSA procedure, the RVU is
272.21 for CPT 55882.
As noted above, the TULSA procedure will have a
0-day Global Period, meaning that all post-operative visits are
billed separately. This is distinct from all other comparable
prostate treatments which are 90-day Global Period and therefore
include bundled payments for all post-operative visits performed in
the first 90 days. The typical range of post-operative office
visits would be approximately 9-11 total RVUs in the first
90-days.
The below tables summarize the proposed rule
Codes, RVUs and Facility Dollar Amounts.
Fee Schedule (Medicare National Average):
CPT Code |
Description |
APC 5377: Level 7 Urology- HOPD |
APC: ASC |
55882 |
TULSA Complete Procedure |
$12,992.42 |
$10,728.00 |
Physician Fee Schedule:
CPT Code |
Description |
Physician Total RVU |
Typical 90-Day Follow-up |
Physician Total RVU with Typical 90-Day
Follow-Up |
Facility (HOPD, ASC) |
Non-Facility (OBL) |
Facility (HOPD, ASC) |
Non-Facility (OBL) |
51721 |
TULSA Device Management |
6.47 |
16.25 |
9.37-11.61 |
15.84-18.08 |
25.62-27.86 |
55881 |
TULSA Treatment |
14.56 |
263.05 |
n/a |
14.56 |
263.05 |
51721 & 55881 Total |
Procedure Total |
21.03 |
279.30 |
9.37-11.61 |
30.40-32.66 |
288.67-290.91 |
(Two Physician) |
|
55882 |
TULSA Complete Procedure (One Physician) |
17.91 |
272.21 |
9.37-11.61 |
27.28-29.52 |
281.58 - 283.82 |
About Profound Medical Corp.
Profound is a commercial-stage medical device
company that develops and markets customizable, incision-free
therapies for the ablation of diseased tissue.
Profound is commercializing TULSA-PRO®, a
technology that combines real-time MRI, robotically-driven
transurethral ultrasound and closed-loop temperature feedback
control. The TULSA procedure, performed using the TULSA-PRO®
system, has the potential of becoming a mainstream treatment
modality across the entire prostate disease spectrum; ranging from
low-, intermediate-, or high-risk prostate cancer; to hybrid
patients suffering from both prostate cancer and benign prostatic
hyperplasia (“BPH”); to men with BPH only; and also, to patients
requiring salvage therapy for radio-recurrent localized prostate
cancer. TULSA employs real-time MR guidance for pixel-by-pixel
precision to preserve prostate disease patients’ urinary continence
and sexual function, while killing the targeted prostate tissue via
a precise sound absorption technology that gently heats it to kill
temperature (55-57°C). TULSA is an incision- and radiation-free
“one-and-done” procedure performed in a single session that takes a
few hours. Virtually all prostate shapes and sizes can be safely,
effectively, and efficiently treated with TULSA. There is no
bleeding associated with the procedure; no hospital stay is
required; and most TULSA patients report quick recovery to their
normal routine. TULSA-PRO® is CE marked, Health Canada approved,
and 510(k) cleared by the U.S. Food and Drug Administration
(“FDA”).
Profound is also commercializing Sonalleve®, an
innovative therapeutic platform that is CE marked for the treatment
of uterine fibroids and palliative pain treatment of bone
metastases. Sonalleve® has also been approved by the China National
Medical Products Administration for the non-invasive treatment of
uterine fibroids and has FDA approval under a Humanitarian Device
Exemption for the treatment of osteoid osteoma. The Company is in
the early stages of exploring additional potential treatment
markets for Sonalleve® where the technology has been shown to have
clinical application, such as non-invasive ablation of abdominal
cancers and hyperthermia for cancer therapy.
Forward-Looking Statements
This release includes forward-looking statements
regarding Profound and its business which may include, but is not
limited to, the expectations regarding the efficacy of Profound’s
technology in the treatment of prostate cancer, BPH, uterine
fibroids, palliative pain treatment and osteoid osteoma; and the
success of Profound’s U.S. commercialization strategy and
activities for TULSA-PRO®. Often, but not always, forward-looking
statements can be identified by the use of words such as "plans",
"is expected", "expects", "scheduled", "intends", "contemplates",
"anticipates", "believes", "proposes" or variations (including
negative variations) of such words and phrases, or state that
certain actions, events or results "may", "could", "would", "might"
or "will" be taken, occur or be achieved. Such statements are based
on the current expectations of the management of Profound. The
forward-looking events and circumstances discussed in this release,
may not occur by certain specified dates or at all and could differ
materially as a result of known and unknown risk factors and
uncertainties affecting the Company, including risks regarding the
medical device industry, regulatory approvals, reimbursement,
economic factors, the equity markets generally and risks associated
with growth and competition. Although Profound has attempted to
identify important factors that could cause actual actions, events
or results to differ materially from those described in
forward-looking statements, there may be other factors that cause
actions, events or results to differ from those anticipated,
estimated or intended. No forward-looking statement can be
guaranteed. In addition, there is uncertainty about the spread of
the COVID-19 virus and the impact it will have on Profound’s
operations, the demand for its products, global supply chains and
economic activity in general. Except as required by applicable
securities laws, forward-looking statements speak only as of the
date on which they are made and Profound undertakes no obligation
to publicly update or revise any forward-looking statement, whether
as a result of new information, future events, or otherwise, other
than as required by law.
For further information, please contact:
Stephen KilmerInvestor Relationsskilmer@profoundmedical.com T:
647.872.4849
Susan ThomasPublic Relationssthomas@profoundmedical.com T:
619.540.9195
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