Estimated Medicare patient out-of-pocket costs for the WATCHMAN Implant
A typical Medicare patient in 2024 will pay no more than $2,607 in OOP costs to receive the WATCHMAN Implant.
| Preparing for WATCHMAN | |
|---|---|
| Pre-screening TEE1,2 | $126 |
| |
|
| |
|
| Total | $126 |
| WATCHMAN Implant | |
|---|---|
| Inpatient deductible3 (Medicare Part A) |
$1,632 |
| Medical Services3 Deductible (Medicare Part B) |
$240 |
| Implant procedure | |
| Implanting Physician Fee | $152 |
| Anesthesiologist Fee | $86 |
| Intraoperative TEE Fee | $44 |
| Total | $2,154 |
| Post WATCHMAN Therapy | |
|---|---|
| Warfarin/Clopidogrel/ASA through 1 year4 |
$75 |
| 45-day follow-up TEE2 | $126 |
| 1-year follow-up TEE2 | $126 |
| |
|
| |
|
| Total | $327 |
| Total estimated patient OOP costs*: $2,607 |
Total out-of-pocket spending for the WATCHMAN LAAC Implant was lower than that of warfarin and non-vitamin K oral anticoagulants (NOACs) by year 5.
The WATCHMAN Implant provided Medicare patients with lower OOP costs at 5 years relative to both warfarin and NOACs.
Annual cumulative patient OOP costs5
The WATCHMAN Implant had lower patient OOP costs than NOACs by year 3 and warfarin by year 4.5
Average total OOP costs at year 55
The WATCHMAN Implant was 33% less expensive than NOACs and 26% less expensive than warfarin by year 5.5
Access WATCHMAN Implant information, studies, and more
References:
1. Represents all WATCHMAN models, including WATCHMAN FLX Devices.
2. The pre-screen TEE cost will be different if it is completed within 72 hours before hospital admission due to the 3-Day Payment window. 3. Source: CMS MLN Matters, SE20024, December 3, 2020.
3. Patient Costs are calculated based on Medicare beneficiaries 20% coinsurance payment for Part B services, for both hospital (where applicable) and physician work. Rates are 2023 Medicare rates set by the CY2023 CMS Physician Fee Schedule and CY2023 CMS Hospital Outpatient Prospective Payment System Annual Rules. CF= $33.8872. Payments from Optum, Inc. Accessed 01/04/2023.
4. Traditional Medicare beneficiaries 2023 Deductible for Part A ($1,600) and B ($226) may have already been met for patients if they have had prior medical services unrelated to WATCHMAN procedures.
5. Source: GoodRx.com, Walmart pricing for Warfarin, Clopidogrel and ASA.
Note: Estimated costs are based on national averages of 2024 U.S. Medicare rates, and assume a 20% copay for Medicare Part B. These estimates will vary depending upon the patient’s individual healthcare policy. Insurance coverage can vary significantly from one plan to another, even within the same insurance company. We therefore recommend that patients contact their insurance provider directly with questions regarding estimated patient-specific out-of-pocket costs.
Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services.
It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently. Boston Scientific recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.
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