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The Reimbursement Top Ten Checklist: Understanding How Coverage, Codes and Payment Impact the Success of a New Medical Technology

So, where do you begin the reimbursement due diligence to formulate your plan for a new medical technology? What are the critical factors to identify and incorporate into the strategy? What are the main elements that are imperative to know? The checklist below highlights those key drivers of reimbursement that will determine the current reimbursement landscape of a medical technology.

More importantly, this information will define the reimbursement strategy and allow companies to have a well-designed strategic reimbursement plan early, impacting success in the future.

1. Who are the key stakeholders?

  • Specific setting of care
  • Healthcare professional
  • Insurance entity

Who will be purchasing, using and paying for the product or procedure?

2.  Are there existing codes? What are they?

  • CPT® (Current Procedural Terminology)
  • ICD-9-CM (International Classification of Diseases - 9th Revision Clinical Modification)
  • HCPCS (Healthcare Common Procedure Coding System)

If so, have the codes been validated as appropriate for use to report the new technology through the appropriate entities? Codes are never determined in a boardroom. If you are not sure, seek the advice of the Professional Society, American Medical Association or CMS.