Securing Codes and Reimbursement for New Products
Let CodeMap assist in developing a strategy for achieving optimal coding and Medicare reimbursement for your new clinical laboratory and diagnostic products. Our approach to solving coding and reimbursement problems generally involves the following steps.
- We analyze existing codes, reimbursement and coverage to determine if it is adequate to cover the anticipated costs associated with your new product. If a suitable combination of existing codes can be employed and billed according to Medicare rules, the engagement ends at this point.
- If existing CPT® or HCPCS codes can not be used to accurately describe your product, or are inadequately reimbursed to make the product economically feasible, we will assist in obtaining a new code or modifying existing codes to accurately describe your new product. This process can take as long as 18 months, so be sure to plan ahead.
- Once a new code is obtained, CodeMap will assist you developing a successful strategy for securing appropriate reimbursement for the code from the Centers for Medicare and Medicaid Services (CMS).
- After appropriate reimbursement is achieved, CodeMap can also assist in securing favorable Medicare coverage policies (either national or local) for the new product by working with Medicare contractors and CMS to inform and convince them of the clinical value of the test.
CodeMap has successfully assisted over 45 prominent diagnostic companies in obtaining new codes and reasonable reimbursement for numerous new clinical assays including hsCRP, urine electrophoresis, lactoferrin, lipoprotein-associated phospholipase, West Nile virus, methicillin resistant Staph. aureus, Aspergillus and Trichomonas vaginalis to name a few. In addition, as of October 2019, we are currently engaged in 23 PLA Code requests.
Please contact Dr. Charles Root at 847-381-5465 or firstname.lastname@example.org to discuss your specific needs.