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BioWorld - Sunday, April 19, 2026
Home » Topics » Regulatory » Medicare

Medicare
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Gears with regulatory words

MDMA urges CMS to craft separate outpatient payments for RDN devices

Sep. 19, 2024
By Mark McCarty
The U.S. CMS believes it has a quandary on its hands with regard to transitional pass-through payment for renal denervation devices, but the Medical Device Manufacturers Association urged the agency to provide separate payment mechanisms for these devices as seen in the inpatient final rule.
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US flag, gavel, book

DOJ tracking device industry’s coverage and coding recommendations

Sep. 13, 2024
By Mark McCarty
The U.S. Department of Justice reported that THD America Inc., and its Italian corporate parent company agreed to pay $700,000 over inducing physicians to use incorrect payment codes in Medicare and Medicaid claims.
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Medicare puzzle

Medicare contractors withdraw policy for allograft rejection testing

Aug. 26, 2024
By Mark McCarty
The U.S. CMS said its Medicare administrative contractors withdrew a draft local coverage determination that would have restricted the use of surveillance testing for allograft rejection.
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Gears with regulatory words

Lack of UDIs on claims forms still a source of drag on FDA surveillance

Aug. 20, 2024
By Mark McCarty
The U.S. Government Accountability Office’s report on FDA oversight of medical devices acknowledges that the agency has made strides in its efforts to develop surveillance systems to track adverse events, but there are shortcomings.
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Medicare puzzle

Medicare inpatient final rule adds DRG for ablation, LAA closure

Aug. 15, 2024
By Mark McCarty
Device makers and physicians alike were less than enthused about several features of the draft Medicare inpatient rule for fiscal year 2025, but thanks in part to support from the device industry, the final rule provides a new code that encompasses both left atrial appendage closure and ablation, a change that may reduce spending without dinging sales of these devices.
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US HHS wins another round; associational standing questioned

Aug. 12, 2024
By Mari Serebrov
In turning the U.S. Department of Health and Human Services’ (HHS) one initial defeat into a victory, a federal district court handed HHS a 7-0 record in getting constitutional challenges to Medicare price negotiations dismissed.
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Medicare puzzle

US Medicare’s TCET final fuzzy on definition of ‘similar device’

Aug. 8, 2024
By Mark McCarty
The U.S. CMS announced the release of the Transitional Coverage for Emerging Technologies policy, which is less than clear on the definition of a key term.
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Medicare puzzle

Industry supportive of new DRG code for combination of procedures

July 30, 2024
By Mark McCarty
The U.S. CMS proposed a series of changes to the Medicare series of codes for diagnostic-related groups, and device makers had pointed remarks about some of those proposals.
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guardant bloodkit

Guardant wins nod from FDA for Shield test for colorectal cancer​

July 29, 2024
By Mark McCarty
The U.S. FDA approved the PMA application for the Shield test by Guardant Health Inc., a diagnostic for colorectal cancer that avoids some of the issues with alternative diagnostic methods. There are lingering questions about Medicare coverage and physician adoption, however, the answers to which may take a couple of years emerge.
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Elderly woman holding illustration of brain with missing puzzle piece

Regulatory flexibility shown in cancer space needed in Alzheimer’s

June 14, 2024
By Mari Serebrov
Just as it is for terminally ill cancer patients, time is of the essence for people in the early stages of Alzheimer’s disease. Thus, the clinical meaningfulness of Eli Lilly and Co.’s donanemab is the time it gives patients before the disease progresses, Reisa Sperling, a neurology professor at Harvard Medical School and director of the Center for Alzheimer’s Research and Treatment at Brigham and Women’s Hospital, told the U.S. FDA’s Peripheral and Central Nervous System Drugs Advisory Committee June 10.
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