Covering New Ground

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