ON-Q* & ambIT* Pumps Eligible for Separate Payment Under NOPAIN Act: A Boon for Non-Opioid Pain Management

The Centers for Medicare and Medicaid Services (CMS) has announced that the Avanos ON-Q* elastomeric infusion pump and ambIT* disposable electronic infusion pump will be eligible for separate payment under the Non-Opioid Policy for Pain Relief (NOPAIN) Act, effective January 1, 2025. This significant development is set to enhance patient access to non-opioid pain management options and contribute to the broader strategy of combating the opioid crisis.

The NOPAIN Act, passed as part of the Consolidated Appropriation Act of 2023, aims to increase patient access to non-opioid drugs and devices used to manage pain in Hospital Outpatient (HOPD) and Ambulatory Surgery Center (ASC) settings. By providing additional Medicare reimbursement for qualifying non-opioid items, the act seeks to reduce opioid reliance and promote safer pain management alternatives.

Both the ON-Q* and ambIT* infusion pumps have been clinically proven to reduce opioid use after surgery, with patients reporting up to 69% lower pain scores and being up to 3x as likely to report high satisfaction scores. With the confirmation of separate payment for these pumps under the NOPAIN Act, healthcare providers will now receive additional reimbursement for using these non-opioid pain management solutions in HOPD and ASC settings.



The separate payment provision will likely encourage healthcare providers to adopt these non-opioid pain management delivery systems, reducing reliance on opioids in postoperative care. This shift in pain management practices will contribute to the broader strategy of combating the opioid crisis by promoting safer pain management alternatives.

The new unique Healthcare Common Procedure Coding System (HCPCS) codes for ON-Q* (C9804) and ambIT* (C9806) pumps will enable separate payment for these non-opioid pain management delivery systems in HOPD and ASC settings. This change will make these pumps more attractive to healthcare providers, as they can now be reimbursed separately for using these pumps, in addition to the related APC payments.



The NOPAIN Act's sunset clause in 2027 may impact Avanos Medical's long-term planning for ON-Q* and ambIT* infusion pumps. While the separate payment provision until 2027 encourages adoption, post-2027, Avanos must focus on demonstrating the pumps' cost-effectiveness and clinical benefits to maintain market share. This may involve investing in further clinical trials and data collection to prove the pumps' value beyond the NOPAIN Act's scope.

In conclusion, the separate payment for ON-Q* and ambIT* pumps under the NOPAIN Act is a significant milestone in promoting non-opioid pain management solutions. This policy aims to reduce opioid reliance and promote safer pain management alternatives, ultimately contributing to the broader strategy of combating the opioid crisis. With the confirmation of separate payment for these pumps, healthcare providers will now have more incentives to adopt these non-opioid pain management delivery systems, leading to improved patient outcomes and reduced reliance on opioids.