Medical Devices Today

Radiology Benefits Managers Offer Medicare Cost-Saving Option For Imaging

From the July 2, 2007, issue of "The Gray Sheet"

An insurance company strategy to rein in perceived overuse of imaging services has gained traction in Congress for its potential as a Medicare cost-saver.

The approach: private payers contract with third parties to act as "gatekeepers" for imaging coverage. Radiology benefits managers (RBMs), as they are called, review physicians' imaging study orders, excluding inpatient services, for prior authorization before allowing coverage.

RBMs argue that inappropriate use of high-cost imaging services like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) happens too frequently and reducing it can increase quality of care and save significant money.

CMS Backs Away From Expanding Carotid Stenting Coverage

From the May 7, 2007, issue of "The Gray Sheet"

CMS has reversed its earlier proposal to significantly expand coverage of carotid stenting, dampening industry's hopes for a more open U.S. carotid stent market in the near term.

The April 30 decision essentially maintains a 2005 policy that covers carotid stenting in patients for whom the "gold standard" endarterectomy surgery is too risky and who have symptomatic blockage >70% in their neck arteries. CMS covers high-risk symptomatic patients with between 50% and 70% blockage and asymptomatic patients with >80% blockage only in FDA-approved studies.

Following a March 2006 request from Guidant to more closely align Medicare coverage with the devices' FDA indications, in February CMS proposed to extend unrestricted carotid stenting coverage to high-risk, asymptomatic patients with blockage >80%. That policy would have doubled the population covered for the procedure, according to industry.

CMS Proposes Unique Codes For Continuous Glucose Monitoring

From the April 16, 2007, issue of "The Gray Sheet"

CMS is proposing to establish unique codes for continuous glucose monitors, a decision that could help manufacturers secure reimbursement from both Medicare and private payors.

If the proposal is finalized in November, the creation of three separate level-II HCPCS codes for subcutaneous disposable sensors, external transmitters and receivers would reverse the agency's decision last year to deny unique codes for the new technology.

For InSightec, CMS Holds Ticket To Treating Fibroids In Younger Women

From the March 19, 2007, issue of "The Gray Sheet"

The lack of third-party reimbursement has hindered sales of InSightec's ExAblate 2000 uterine fibroid treatment, but the firm is hopeful that recent recommendations from CMS' advisory panel for hospital outpatient payments will help the unique treatment gain traction.

"The CMS payment level is really critical to providing access to this technology, and it's really what is holding back widespread adoption," InSightec Director of Marketing Lynn Golumbic told "The Gray Sheet."