Reimbursement is an increasingly important consideration in the development and marketing of medical devices and Bard recognizes its critical importance to the customers who use our products worldwide.
As the largest single healthcare insurer in the U.S., Medicare has a profound influence on the healthcare market. The Centers for Medicare and Medicaid Services (CMS) formulate national and local coverage policy and set reimbursement rates for facility and physician providers. As for commercial payers, managed care organizations cover approximately 200 million individuals in the U.S. and these payers often follow the lead set by CMS when determining their own coverage and payment guidelines.
Regardless of the payer, three basic steps must occur for the product or procedure to be considered reimbursable:
- First, payers must consider the product or procedure as a part of a covered set of benefits
- Second, a billing code must exist or be established to identify the product or procedure
- Finally, payment must be assigned for the code
In general, the complexity and integration of these processes are significant challenges for manufacturers seeking to bring products to market. The Bard Corporate Reimbursement Department seeks to work with decision-makers including government agencies, specialty medical societies and public and private payers to ensure our products are appropriately reimbursed in the marketplace.
For many Bard products, considerations necessary to establish reimbursement are already established as their use falls under existing categories of care, such as those for inpatient hospital services or outpatient and ambulatory care settings. Under such systems, a prospective payment bundle (DRG or APC) is set to include costs of services and products needed to provide a specific procedure or episode of care. Bard continually monitors the sufficiency of these reimbursements and takes actions to ensure they are adequate and appropriate.
Facility and Physician Payment Rates
Select the business unit below to search for reimbursement information.
Bard Access Systems, Inc.
Bard Medical Division
Bard Peripheral Vascular, Inc.
Bard Biopsy Systems
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at http://www.icd10data.com/Convert.
Beginning April 1, 2001, Medicare used a system of product-specific HCPCS codes called C-codes to reimburse or pass-through the cost of implantable devices under the Outpatient Prospective Payment System (OPPS). As this payment system evolved, the majority of C- codes have been eliminated as their costs were folded into the reimbursement of procedures under Ambulatory Payment Classifications (APCs). However, effective January 1, 2004, Medicare reactivated approximately 95 categories of devices and their C-codes for tracking and reporting purposes.1 These C-codes were published in Addendum B on the CMS OPPS website in April of 2004.
Although these C-codes have been reinstated, Medicare will continue to reimburse hospitals for most implantable devices under the Ambulatory Payment Classification System.
Click on the following link for Bard Product C Codes: Category Codes (C codes) for Medicare Hospital Outpatient
1Federal Register / Vol. 68, No. 216 / Friday, November 7, 2003, pg. 63438
2016 Inpatient Hospital Final Rule
2016 Outpatient and ASC Final Rule
2016 Physician Fee Schedule Final Rule
For questions, comments or concerns regarding reimbursement of Bard products, please use the Contact form provided below: