November 2025 issue, BioElectRx Business Report
November 30, 2025 | Manufacturers of hypoglossal nerve stimulation systems for treating obstructive sleep apnea received some good news on the reimbursement front earlier this month. The U.S. Centers for Medicare & Medicaid Services finalized its CY2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Rule. Within the final rule, CMS assigned CPT Code 64568, the code used for HGNS implants, to New Technology Ambulatory Payment Classification 1580.
Effective January 1, 2026, Hospital Outpatient Department reimbursement for CPT 64568 will increase to approximately $45,000, a 48% rise compared to 2025. In addition, ASC facility reimbursement will increase to $42,373, reflecting a 58% increase compared to 2025. The news caused a 28% spike in the stock price of Inspire Medical Systems on November 24.
These updates apply uniformly to all procedures billed under CPT 64568, including the Inspire V and Nyxoah’s Genio systems, and strengthen the economic foundation supporting therapy adoption across U.S. hospital outpatient departments and ambulatory surgical centers. The CMS decision offers HGNS vendors a stronger reimbursement framework that is expected to support broader adoption, increased procedural throughput, and expansion across Medicare-heavy institutions.
Genio’s single-incision procedure is well suited for the ASC environment, and the significant increase in ASC facility payment creates new opportunities for therapy expansion and site-of-service diversification.
“CMS’ decision to significantly increase reimbursement for CPT 64568 reinforces the growing recognition of hypoglossal nerve stimulation as a high-value therapy for obstructive sleep apnea,” commented Olivier Taelman, Nyxoah’s CEO.“ The new rates create a more favorable environment for expanding access to our Genio therapy across both outpatient hospitals and ASCs.”
Despite the good news, there are a couple caveats that come with the CMS decision. First, this code will be a subject to the government’s Wasteful and Inappropriate Service Reduction (WISeR) program in six states. Also, the code increases reimbursement only for the open-neck implantation surgery, while reimbursement levels for the HGNS IPG and leads are not increased.
