Life Sciences and Healthcare Regulatory

Coverage and Reimbursement

Our preeminent coverage and reimbursement team takes on some of the most difficult payment challenges involving new technology, innovative products, diagnostic tests, and clinical services. Our team consists of attorneys, an economist, health care professionals, scientists, and former leadership from the Centers for Medicare & Medicaid Services (CMS) and the US Department of Health and Human Services. Our experience includes initiatives relating to the coverage, coding, and payment rules for all sites of care and types of products, strategies to obtain new technology and pass-through status, benefit category determinations, CPT and HCPCS coding, national and local coverage issues including coverage with evidence development, parallel review of new products by FDA and CMS, and interacting with CMS on problematic reimbursement issues. We also work with private payers, AHRQ, NIH, FDA. Members of our team regularly attend the meetings of the AMA CPT Editorial Panel and the Relative Value Scale Update Committee, and we counsel clients on related strategies. In addition, we focus extensively on matters relating to product launches, product pricing and price reporting, and doing business with state Medicaid programs, the VA, and DOD.

We work with clients ranging from global companies to venture-backed start-ups as well as medical specialty societies. We work closely with the firm's government relations healthcare team to advise clients on the nexus of legislative and administrative tactics and how to incorporate Congressional attention in resolving important reimbursement issues.


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