Originally Published MX November/December
2001

GOVERNMENTAL &
LEGAL AFFAIRS

Covering New
Ground

CMS is working
to make Medicare’s national coverage process more understandable, predictable,
timely, and inclusive.

John Whyte

Over the past two
years, the U.S. Medicare program has revised its methods for deciding whether
or not to cover a medical device, procedure, or service. The Centers for Medicare
and Medicaid Services (CMS, formerly the Health Care Financing Administration;
Baltimore) has implemented the changes in an attempt to make the program more
understandable, predictable, timely, and inclusive. This article describes some
of the recent changes and discusses the effects they may have on business planning
for medtech manufacturers.



The Social Security Act grants the secretary of Health and Human Services, acting
through CMS, the authority to determine what medical devices, procedures, and
services are covered under the Medicare program. However, the act also restricts
all Medicare coverage and payments to those services that have been found “reasonable