Real-world Evidence Put to the Test: Medicare’s New Codes for Remdesivir

August 8, 2020

The Centers for Medicare & Medicaid Services (CMS) has created new ICD-10-PCS procedure reimbursement codes to facilitate the generation of critical real-world evidence data on the effectiveness of COVID products. However, they warned that these will likely suffer from a “claims lag”. The codes, which went into effect on 1 August, ‘will enable CMS to conduct real-time surveillance and obtain real-world evidence on how these drugs are working and provide critical information on their effectiveness and how they can protect patients,’ the agency announced 30 July. The new codes are the Health Insurance Portability and Accountability Act-designated code set for reporting hospital inpatient procedures, and are developed and maintained by CMS but can be used by other private health insurers as well.

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(Source:  Kelly C, Pink Sheet, August 6, 2020; subscription required)

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