New CMS proposals streamline Medicare coverage, payment, and coding for innovative new technologies

CMS is proposing coverage and payment policy changes regarding Medicare’s durable medical equipment, prosthetics, orthotic devices, and supplies (DMEPOS). The proposed changes would widen the definition of when external infusion pumps are suitable for use in the home and can be covered as durable medical equipment under Medicare Part B. The rule also calls for reducing administrative hurdles, including certain coverage, payment, and coding processes, that prevent innovators from promptly getting their products to Medicare beneficiaries. Previously, the process for making Medicare benefit classifications, pricing determinations, and billing codes for DMEPOS often took up to 18 months to complete. CMS changed the process last year via sub-regulatory guidance to shorten that timeframe to 6 months in many instances, and is now proposing to implement a streamlined process for coding, coverage, and payment in regulation. Under this accelerated process, benefit classification and pricing decisions could occur on the same day that billing codes used for payment of new items become effective. If finalized, the proposed rule would allow innovators to bring their products to Medicare beneficiaries more quickly, and broaden Medicare coverage and payment for continuous glucose monitors (CGMs). CMS currently only covers therapeutic CGMs or those approved by FDA for use in making diabetes treatment decisions.