The Quarter 1, 2022 billing codes for drugs and biologics and MedTech have been posted. However, being assigned a code does not equal market uptake. Here are some tips that are based on more than 19 years of experience on how the assigned codes can be successfully implemented for the market uptake of your #medtech:
- Review our newly posted video on Six Tips to Implement New Billing Codes
- Understand the reimbursement implications of the assigned codes and develop a Billing Guide that is reviewed by reimbursement lawyers with appropriate disclaimers so that the sales force is not pulled into reimbursement discussions and guarantees. Review our Blog on the Most Common Coding Myths.
- The billing code may not be covered by payers. Please refer to our e-book on Essential Steps for U.S. Payer Coverage: The Processes to Get Payer Reimbursement for Biologics, Drugs, Diagnostics, and Medical Devices to get a proven framework for payer coverage for your #medtech.
- Codes that are carrier priced will need work with the payers to educate them on the pricing and clinical and cost data for the new medical technology.
- As payers usually do not directly engage with manufacturers and marketers, to educate payers about your product codes and clinical outcomes, partner with payer advocacy experts with proven success.
- Partner with payer advocacy experts to ensure appropriate coverage and payment for your #medtech and associated services.
- Track the assigned codes as they can change.
- Track the payer coverage policies assigned for the specific codes as they are dynamic.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
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About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.