Payment for many technological advances can be made under one of Medicare’s payment methodologies without being preceded by an explicit coverage determination, coding change, and/or payment decision by CMS.

There are three areas that impact new technology: Coverage, Coding and Payment. CMS states that “Coverage, coding, and payment decisions are not necessarily made in any particular order.”

Medicare’s authority to cover or exclude certain items or services is governed by the Social Security Act (the Act) and implementing regulations.

When looking at a new technology, the following questions should be asked...