ARTICLE SUMMARY:
Billing codes are foundational to a medical technology’s path to market access. Both CMS and the American Medical Association recently posted their latest round of coding system decisions. Here’s a look at a few notable medtech outcomes from the rulings, including for the ReWalk exoskeleton, at-home COVID-19 tests, a contraception app, Alzheimer’s markers, and AI cardiac monitoring tools.
The two organizations that serve as gatekeepers for new codes used to bill for medical services and technologies published their latest rulings last week. CMS posted its biannual summary of Healthcare Common Procedure Coding System (HCPCS) Level II decisions for “non-drug and non-biological items and services” on February 29. And the next day, the American Medical Association’s CPT Editorial Panel posted a summary of decisions made during its February meeting.
HCPCS Level II codes are typically used to bill (to both Medicare and private payors) for care that takes place outside of hospitals and doctors’ offices; they are particularly important for home-based devices including durable medical equipment. Notably, in its biannual HCPCS summaries, CMS not only rules on whether to grant new codes, but also makes determinations on whether the tools fit within a benefit category and how much they should be reimbursed by Medicare. In the February 29 summary, CMS ruled on 50 different device categories, with new or updated codes primarily taking effect on April 1.
CPT codes, meanwhile, underlie billing for care at healthcare facilities in the US. They can be crucial to trying to build up adoption and reimbursement for a new device. The AMA panel controls this process, although it is up to CMS as well as private payors to link CPT codes to payment rates. During its February meeting, the panel made coding decisions for 29 categories of healthcare items and services, accepting 53 new CPT codes, in addition to an array of revisions and deletions. Most of the new codes will take effect in either January 2025 or 2026.
Here, we spotlight a few decisions from these two documents that we found noteworthy from a medtech perspective.
