AMA rejects new CPT code (slight -ve) and revises 64568 to exclude INSP (+ve for

研报英文原文证据摘录

AMA rejects new CPT code (slight -ve) and revises 64568 to exclude INSP (+ve for

Flash Note Health Care | Medical Supplies & Devices

May 15, 2026

Inspire Medical Systems, Inc. Daniel Markowitz Vijay Kumar 212-812-2936 212-653-9033

INSP | $42.66 Daniel.Markowitz@evercoreISI.com Vijay.Kumar@EvercoreISI.com

Outperform | Target Price/Base Case: $55.00 Nicholas Whalen, CFA Kevin Joaquin

Company Update 646-225-6027 212-446-9493

Nicholas.Whalen@evercoreISI.com kevin.joaquin@evercoreisi.com

AMA rejects new CPT code (slight -ve) and revises 64568 to exclude INSP (+ve

for coding uniformity)

What Happened?

• Today, AMA posted a summary of actions from the May CPT Editorial Panel meeting (May 1st) and

rejected the establishment of a permanent Category I CPT code for Inspire V

• Separately, AMA accepted the revision of CPT 64568 to exclude the hypoglossal nerve and refers users to

CPT 64582, effective January 2027

What’s Next?

• Mgmt had previously flagged code rejection as a realistic outcome and appears prepared to work through the

AMA feedback process

• The next CPT Editorial Panel meeting is scheduled for September, giving INSP one more opportunity to

submit its package and remain on track for a January 2028 effective date

Our Takes

• Overall, we see today’s update as mixed… while INSP won’t see reimbursement upside from a new CPT

code, we see the formal revision to 64568 as a positive for coding clarity

o Recall MACs rejected the use of 64568 for OSA several months ago, while commercial + MA

payers have continued to use it

o We believe this formal revision could lead all payers to use 64582 starting in 2027 (no more 64568)

– hence a step towards coding uniformity

• The next step towards improved clarity will be an answer as to whether or not a -52 modifier is needed for