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Policy Category: Reimbursement

PMC advises Medicare and Medicaid officials on reimbursement policies that can help ensure sustainable patient access to personalized medicine. In 2020, for example, PMC began advocating for increased Medicare payment rates for hospitals that provide chimeric antigen receptor T-cell therapies, a potentially life-saving class of personalized cancer treatments. PMC’s recommended payment solution is still in place today.

Medicare Reconsideration of National Coverage for Beta Amyloid PET Scans in Dementia and Neurodegenerative Disease

U.S. House of Representatives Ways and Means Health Subcommittee Hearing on Policies That Inhibit Innovation and Patient Access

Legislation to Ensure Predictable and Sustainable Medicare Payments for Laboratory Services/Saving Access to Laboratory Services Act

CMS’ Request for Information About Opportunities to Improve Care for Patients Covered by Medicare Advantage Plans

CMS’ Proposals Related to Quality Measures in the 2023 Physician Fee Schedule

CMS’ Proposal to Discontinue the Use of ICD-10 NOS Reimbursement Codes

CMS’ Telehealth Policies

CMS’ Clinical Laboratory Fee Schedule

National Government Services’ Proposed Local Coverage Determination on Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

CMS’ Proposal for an Innovative Technology (MCIT) Pathway for Breakthrough Devices and Definition of ‘Reasonable and Necessary’

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