Detailed narrative
Coding and Reimbursement Environment
Inspire is actively educating customers on Inspire V coding and reimbursement, noting improved trends in prior authorization submissions. C-codes are now in place and adopted by WISeR for 6 states, with hospital and ASC reimbursement rates unchanged. Two MACs currently require a -52 modifier for surgeon billing, leading to payment reductions ranging from 0% to 30%, which the company is addressing through customer education on documentation requirements.
Proposed 2027 Reimbursement Rates
CMS has issued proposed 2027 reimbursement rates, including significant increases for facility reimbursement for Inspire V procedures. Hospital outpatient reimbursement is proposed to increase by 12% to $35,414, and ASC reimbursement by 15% to $31,722. However, physician reimbursement for CPT code 64582 is proposed to decrease by approximately 4% to $699. Final rates will be published in November.
New CPT Code Development
The company is supporting the development of a new Category 1 CPT code for a single-lead Inspire system. A revised application, addressing prior coding issues, submitted jointly with another industry participant, and including additional clinical evidence, will be reviewed at the September CPT Editorial Panel Meeting. If approved, the new code is targeted for implementation by January 1, 2028.
Project Horizon Strategic Growth Plan
Inspire announced "Project Horizon," a strategic growth plan designed to accelerate revenue growth by optimizing organizational structure and supply chain. This initiative is expected to create $30 million of annualized growth investment capacity, which will be directed towards enhancing patient access, education, and navigation tools. Early successes include prior authorization support capabilities within the SleepSync platform and the Inspire Connect program for post-implant patient experience.
Clinical Outcomes and Cardiovascular Health
Recent clinical data from the Inspire V trial in Singapore demonstrated the safety and efficacy of the new system. Multiple presentations highlighted growing evidence supporting Inspire therapy's benefits, particularly in improving cardiovascular risk markers. A secondary analysis of the STAR trial showed significant reductions in hypoxic burden, and a TriNetics database study indicated lower odds of stroke, myocardial infarction, and heart failure with hypoglossal nerve stimulation compared to CPAP.
PREDICTOR Study Publication
The publication of the PREDICTOR study identified body mass index (BMI) and neck circumference as predictors of complete concentric collapse. These findings suggest that many patients with a BMI less than 32 may be screened for Inspire therapy eligibility without requiring drug-induced sleep endoscopy (DISE), potentially reducing diagnostic burden, time to treatment, and healthcare costs.
Board of Directors Changes
Casey Tansey retired from the Board of Directors after 18 years of service, having been an early investor and mentor. Mike Carroll, a veteran of the medical device industry with significant executive leadership and Board experience, was welcomed as a new Board member.