What Accurate NTAP Coding and a Program Audit Could Mean for Your Bottom Line

Introduction to NTAP: New Opportunities for Hospitals 

In 2021, the New Technology Add-on Payment (NTAP) program was created by The Center for Medicare & Medicaid Services (CMS) to increase the use of new inpatient technologies in the Medicare population. CMS uses NTAP codes for qualifying products that promise improvement in process or outcomes. Additionally, these new medical services and technologies are eligible for an add-on payment known as NTAP which presents significant reimbursement opportunity for hospitals and healthcare systems that adopt these technologies.  

Eligibility Criteria for NTAP Payments 

To be eligible for the NTAP, these technologies must meet the following 3 criteria. When the following criteria are met, the NTAP payments are significantly greater than the standard Medicare Severity Diagnosis-Related Group (MS-DRG). 

1.) Technology must be new within 2-3 years of market introduction.  

2.) The technology must “substantially improve the diagnosis or treatment relative to currently available technologies and are inadequately paid otherwise under the current diagnosis-related group (DRG) reimbursement rates.”1  

3.) The technology is deemed inadequately compensated under the current MS-DRG, as its average standardized charge for inpatient cases exceeds the set cost threshold. 

The number of approved technologies has increased each year since its inception. The FY 2025-year list is the most extensive since the program began and includes 39 Total NTAPs.   

• CMS finalized the continuation of new technology add-on payments for 24 existing new technologies 
• CMS finalized discontinuing new technology add-on payments for 7 current new technologies   

• CMS finalized 16 of the original 27 new technologies submitted for new technology add-on payments under the traditional and alternative pathways 

 Financial Impact: What NTAP Can Mean for Your Hospital’s Reimbursement 

According to CMS, new technology add-on payments are limited to the lesser of 65% of the costs of the technology, or 65% of the amount by which the costs of the case exceed the standard MS–DRG payment”. 

The most substantial financial impact approved for FY 2025 Casegevy and Lyfgenia. Both are medications for gene therapies that treat sickle cell disease. These medications qualify for 75% NTAP amount resulting in a maximum payment of $1.65 Million for Casgevy and $2.32 Million for Lyfgenia. 

For hospitals and health systems, it is essential to take the following steps to ensure full NTAP reimbursement: 

• Accurate Coding : Make sure the correct ICD-10-PCS code(s) are included on claims to qualify for NTAP payments. Missing or inaccurate codes can lead to lost revenue.   

• Annual Review of NTAP Services: Each year, inpatient coding staff should review the latest list of approved NTAP services and technologies to stay updated on new opportunities for reimbursement.   

• Routine Audits : Conduct regular internal and external audits to confirm that all eligible procedures and technologies are correctly coded and reimbursed. These audits help identify and prevent potential revenue leakage. 

Taking these proactive measures can help ensure your hospital captures all eligible NTAP reimbursements. 

Not Sure if You’re Capturing All Possible NTAP Revenue?   Contact UASI for a comprehensive NTAP assessment. Our expert audit team is ready to help your hospital secure eligible NTAP payments and maximize revenue potential.  

 Do not let money slip through the cracks - Reach Out Today!  

References 

1. Adoption and Trends in the Medicare New Technology Add-On Payment Program - PubMed Central (PMC)  

1. New Medical Services and New Technologies - Centers for Medicare & Medicaid Services (CMS)