If you have questions....We have answers
Ensure market access. Understand the landscape
Coverage
- How likely will there be an LCD or NCD?
- How will it be covered if there is no coverage policy
- Does breakthrough status affect coverage? If so, how?
- Can I, or should I, request an LCD?
- What criteria will drive coverage?
Coding
- Will a existing code be used for my product/service?
- If not, do I need a specific code or should I use an unlisted code?
- What are the pros and cons of specific vs. unlisted codes relative to coverage and utilization
- How do I apply for a code? When should I apply ? Will I get a code?
- What are category III codes? How are they covered?
Reimbursement/Pricing
- How will the price be determined?
- Will reimbursement differ between the physician office and hospital outpatient department? If so, how?
- Will transitional pass through payment apply? Will new technology add on payment apply? What criteria merit these payments?
- How are APCs categorized? Which APC will determine pricing for my product/service?
- Which DRG might apply to my product/service? Would this qualify for a new technology DRG?