University at Buffalo 1-6 credit Management and Policy
The requirements and steps necessary to obtain CPT code approval from the American Medical Association for CMS will be described. The course will address the importance of consideration of reimbursement pathways early in the product development process when regulatory challenges often monopolize focus, and identify different strategies for achieving favorable reimbursement. The mechanics of requesting CPT code will be described including the importance of engagement with relevant professional societies, criteria for successful applications and the code valuation process. Considerations for use of an existing code and managing an unlisted code designation will be examined. Discussions will also cover insurance payer requirements for coverage beyond CPT assignment, the planning and optimum timing to address those requirements and business impact. Lastly, alternative strategies for unfavorable coverage policies will be considered.
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