Innovation policy experts from Stanford's Biodesign center have published a new paper about the coding ecosystem and the innovation system and where they can come into opposition.
Find the paper here:
Here's Stanford Byers Center overview from Linked In:
“For medical innovators, the process of applying for and achieving a CAT I CPT code is a challenging and costly process that has become fundamental to unlocking reimbursement and patient access in the United States. The CAT I requirement of “widespread use,” in particular, has become a roadblock for innovators with novel products or services and the physicians that use them, that is having a negative impact on the innovation ecosystem and patient care. There is a strong and near-term need for a more transparent, predictable, and achievable CAT I CPT code process to ensure that healthcare innovation and patient access to FDA-cleared and clinically proven therapies can flourish and be preserved for future generations.”
Read our latest research on the challenges of the CPT coding process and its impact on the innovation ecosystem.
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A GPT4 summary:
The report explores significant challenges in obtaining Category I Current Procedural Terminology (CPT) codes, which are essential for medical innovators to secure reimbursement and patient access for new medical technologies in the U.S. The process is marked by stringent criteria including "widespread use" and documented clinical efficacy, which pose barriers particularly for novel technologies. Survey data from stakeholders highlighted issues such as the high costs, resource demands, and lack of transparency in the CPT code application process. Respondents advocated for a more transparent and predictable process to foster healthcare innovation and improve patient access to new therapies. Recommendations include refining the "widespread use" criteria and enhancing collaboration between innovators, physicians, and medical societies to streamline the CPT code application and approval processes.
