CMS to Revise Coding Application Process

Baltimore

In an effort to get new product technologies to patients more quickly, CMS has unveiled a plan to revise its coding application process.

“This is a giant step,” said Marcia Nusgart, executive director for the Coalitions of Respiratory Care, Seating and Positioning, Enteral Nutrition and Wound Care Manufacturers. The groups have been pushing for a modernized Health Care Common Procedure Coding System (HCPCS) application process for the past four years.

The changes are “going to make the process a lot more understandable as well as transparent,” said Nusgart, who presented recommended changes to CMS during the past several months. “We are very pleased that CMS responded to many of our recommendations.”

The agency plans to:

• Expand HCPCS public meetings for DME to include other medical supplies and services.
• Implement an appeals process for denied applicants during the 2007 coding cycle.
• Include a public notice of preliminary and final decisions.
• Revise the HCPCS code application form to be more streamlined and incorporate suggestions CMS received from a stakeholder survey.
• Consider codes that may be needed based on Medicaid program operating needs. Due to HIPAA, Medicaid must now conform to the HCPCS coding system.
• Require manufacturers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) to submit marketing data for three months, instead of six.

CMS plans to phase in these changes over an 18-month period beginning with the 2006 coding cycle. The first change will occur with the coding application deadline, pushed up from April 1 to Jan. 3, 2005 to “permit expanded opportunities for public comment on preliminary coding decisions,” according to a CMS press release.

The changes are among the first actions taken by CMS’ new Council on Technology and Innovation, which was established under MMA to coordinate activities of coverage, coding and payment processes affecting new technologies and procedures.