Coverage & Coding

The Medicare program’s coverage for medical products and services for millions of beneficiaries. The majority of the agency’s coverage is provided on a local level, and developed by clinicians at contractors that pay Medicare claims. Sometimes, Medicare develops national coverage determinations for items or services that are applied on a national basis for all beneficiaries meeting the coverage requirements.

AdvaMed’s Medicare Coverage Positions

AdvaMed Policy Statement on Evidentiary Standards used in the National Coverage Process (pdf)
Improving the Medicare Coverage Process (pdf)
Medicare DMERC Coverage Policy (pdf)

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Member Alerts

Coding Issues

Medicare uses its coding process to pay the claims of the program’s beneficiaries. The Medicare coding process draws on the Current Procedural Terminology system that was developed by the American Medical Association, to identify medical services and procedures furnished by physicians and other health care professionals.