At-Home Payment Structure

Florida At-Home Payments (Post-Op Knee Rehab) Pre-FDA:

Post-FDA approval = 10.1-13.1x ROI (save $1500 per each set of 10 now. Price goes up $1500 after approval.)

Private Plans (e.g., Florida Blue) pre-FDA: 7.7x ROI

  • Rate: $185/month per patient.
  • Details: 98977 ($65/month) + 98980 ($30/20 minutes, up to 4 sessions/month).

Ongoing Fees (98977 + 98980): These are billed monthly per patient during their episode of care.

Per Patient: $185/month (98977: $65 + 98980: $120).
98977 (device/monitoring): $65/month.
98980 (treatment): $30/20-minute session, 4 sessions/month (Florida Blue allows up to 4 sessions for post-op knee rehab, per CMS 2025 RTM guidelines).
Total: $65 + $120 = $185/month.
Set up per Set CPT 98975 (4 Patients): Each patient uses the set for 3 months ($19.38 per patient set up)
Total per Set (Including Setup): $185/mo. x 12 = $2,220/set/year + $77.52 (setup for 4 patients) = $2,297.52/set/year.
Total for 10 Sets: $2,297.52 x 10 = $22,975.20/year.
ROI: $22,975.20 ÷ $2,997 = 7.7x ROI

Florida Medicaid Managed Care (MCOs) pre-FDA: 3.5-4.5x ROI

Ongoing Fees (98977 + 98980): These are billed monthly per patient during their episode of care.

Per Patient: $80.98-$106.24/month (98977: $55.72 + 98980: $25.26-$50.52).
98977 (device/monitoring): $55.72/month.
98980 (treatment): $25.26/20-minute session, 1-2 sessions/month (CMS cap).
Low End: $55.72 + $25.26 (1 session) = $80.98/month.
High End: $55.72 + $50.52 (2 sessions) = $106.24/month.
Set up per Set CPT 98975 (4 Patients): Each patient uses the set for 3 months ($19.38 per patient set up)
Total per Set (Including Setup): $971.76 per year-$1,274.88/set/year + $77.52 (setup for 4 patients) = $1,049.28-$1,352.40/year per set.
Total for 10 Sets: $1,049.28 x 10 = $10,492.80-$13,524.00/year.
ROI: $10,492.80 ÷ $2,997 = 3.5x ROI
ROI: $13,524.00 ÷ $2,997 = 4.5x ROI

Florida Medicaid (Fee-for-Service pre FDA): 3.5x ROI

Ongoing Fees (98977 + 98980): These are billed monthly per patient during their episode of care.

Per Patient: $80.98/month (98977: $55.72 + 98980: $25.26).
Set up per Set CPT 98975 (4 Patients): Each patient uses the set for 3 months ($19.38 per patient set up)
Total per Set (Including Setup): $971.76 (ongoing) + $77.52 (setup for 4 patients) = $1,049.28/year per set.
Total for 10 Sets: $1,049.28 x 10 = $10,492.80/year.
ROI: $10,492.80 ÷ $2,997 = 3.5x ROI

Sources:

Florida Agency for Health Care Administration - Rule 59G-4.002, Provider Reimbursement Schedules

CMS Therapy Services - CY 2025 Updates

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Oregon At-Home Payments (Post-Op Knee Rehab) Pre-FDA:

Post-FDA approval = 10.1-13.1x ROI (save $1500 per each set of 10 now. Price goes up $1500 after approval.)

Private Plans (e.g., Regence BlueCross BlueShield of Oregon) (Pre-FDA): 
8.1x ROI

Ongoing Fees (98977 + 98980): $195/month (98977: $70 + 98980: $125, 4 sessions).
Setup per Set CPT 98975 (4 Patients per sensor set per year): $20.50/patient x 4 = $82.00/set.
Total per Set (Including Setup): $2,422/year.
Total for 10 Sets: $24,220/year.
ROI: 8.1x.

Oregon Coordinated Care Organizations (CCOs) (Pre-FDA): 3.6-4.7x ROI

Ongoing Fees (98977 + 98980): $83.80-$110.30/month (98977: $58.30 + 98980: $25.50-$52.00, 1-2 sessions).
Setup per Set CPT 98975 (4 Patients per sensor set per year): $20.50/patient x 4 = $82.00/set.
Total per Set (Including Setup): $1,087.60-$1,405.60/year.
Total for 10 Sets: $10,876.00-$14,056.00/year.
ROI: 3.6x-4.7x.

Oregon Medicaid (OHP) Fee-for-Service (Pre-FDA): 3.6x ROI

Ongoing Fees (98977 + 98980): $83.80/month (98977: $58.30 + 98980: $25.50).
Setup per Set CPT 98975 (4 Patients per year for each sensor): $20.50/patient x 4 = $82.00/set.
Total per Set (Including Setup): $1,087.60/year.
Total for 10 Sets: $10,876.00/year.
ROI: 3.6x

Post-FDA (All Plans): 10.1-13.1x ROI

Rate: $275-$350/month.
Total for 10 Sets (After $300/Month Fee): $30,220-$39,220/year.
ROI: 10.1x-13.1x.

Sources:

Oregon Health Authority - Oregon Health Plan Billing Guidance

CMS Therapy Services - CY 2025 Updates

No Storage and Dashboard Monthly Fees Until FDA Approval.

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