Approval gets you a product. Reimbursement gets you a business.

Category I, II, and III applications to the AMA CPT Editorial Panel — plus PLA codes and the coverage pathway work diagnostics actually live or die on. For devices, diagnostics, and physician-administered technologies alike.

• Category I vs. Category III strategy and timing against FDA authorization; the Editorial Panel meets three times a year, on application deadlines set months ahead
• Full application drafting: clinical vignettes, literature, and utilization rationale
• RUC / valuation preparation so the code lands with a payable value
• PLA codes for proprietary diagnostics — quarterly application and effectuation cycle, and the PLA-vs.-Category I decision: proprietary and fast, or established and broadly payable
• CLFS payment strategy — whether CMS crosswalks your test to an existing rate or gapfills it through the MACs, and what each route does to your first years of payment
• Coverage pathway work, in scope: LCD landscape analysis, MolDx technical-assessment support, and payer sequencing — the code gets you listed; coverage gets you paid

Best when: your technology needs a procedure or service code that payers will actually recognize — not a workaround.

The application CMS actually reads — built the way the HCPCS Workgroup evaluates it, precedent by precedent. Drugs and biologics file on quarterly cycles; devices, supplies, and DME file on biannual cycles.

• Full MEARIS CMS-10224 answers (Questions A–N) with evidence binder
• J-codes, A/E/K/Q and other Level II families; descriptor & billing-unit design with JW/JZ waste math
• Existing-code analysis — why a miscellaneous code or a packaged supply code won’t do
• Therapeutic / functional distinction case with systematic literature review, including unfavorable articles
• Every draft scored in a Workgroup simulation before it files — how the simulation works

Best when: you’re 12–24 months from launch and the trial or evidence plan can still capture what the application will need.

Diagnosis and inpatient-procedure codes through the ICD-10 Coordination & Maintenance Committee (CMS + CDC/NCHS). Without the right ICD-10 code, the claim has nothing to hang on.

• ICD-10-CM new diagnosis codes and Tabular / Index revisions
• ICD-10-PCS new technology Section X and procedure codes for inpatient cases
• Committee proposal drafting, presentation support, and comment-cycle strategy
• Alignment of ICD-10 with CPT/HCPCS so inpatient and outpatient stories agree

Best when: your product treats a condition or is used in a procedure that the current code set describes poorly — or not at all.

The supplemental-payment pathways that make new technology viable while the data catch up — inpatient NTAP under IPPS and transitional pass-through under OPPS.

• IPPS New Technology Add-on Payment (NTAP): eligibility, cost-threshold modeling, and application
• Alternative NTAP pathway support for Breakthrough Devices and qualified technologies
• OPPS transitional pass-through (§419.64 cost tests) and §419.2(b)(16) supply-packaging defense
• APC-by-APC dollar hurdles and post-pass-through / post-NTAP cliff planning
• Site-of-care strategy across physician office, ASC, HOPD, and inpatient

Best when: the base payment doesn’t cover your technology yet and you need the bridge — modeled before you promise anyone a number.

Applications to the Medicare Pricing, Data Analysis and Coding (PDAC) contractor — the coding verification and DMEPOS determinations that decide how DME, prosthetics, orthotics, and supplies get billed.

• PDAC Coding Verification Review applications for DMEPOS products
• Correct Coding Initiative and product-classification strategy
• Level II code verification letters and re-review / reconsideration support
• Billing and documentation guidance aligned to the PDAC determination

Best when: your device or supply needs a defensible HCPCS assignment that DME MACs will honor on the first claim.

WAC is a one-way door and payment policy moves quarterly. We run the analysis before pricing locks — and provide fractional leadership when you need it.

• WAC / ASP trajectory modeling, ASP+6% office economics, and IRA inflation-rebate exposure
• Commercial & Medicaid payment cross-checks by setting; UB-04 / claim-form readiness
• Launch readiness: interim miscellaneous-code playbook before the permanent code lands
• Payer policy monitoring, denial triage, sales-team guardrails, and quarterly steering reviews
• Pricing checked in models built for the decision at hand — §419.64 cost tests, Question N consistency — against filings experience going back to 2001

Best when: approval is in sight and reimbursement is about to become daily weather — not an episodic project.

Codes get you recognized; DRGs and APCs decide what the case actually pays. We build the classification requests that place a new technology in the right payment group — inpatient MS-DRGs under IPPS and new technology APCs under OPPS.

• New DRG applications and MS-DRG assignment requests — severity logic, CC/MCC structure, and the case-cost data CMS's annual rulemaking runs on
• ICD-10-PCS code-to-DRG mapping analysis, so the procedure code and the payment group tell the same story
• New technology APC applications under OPPS, including device and service category placement
• Case-cost and charge modeling that shows whether the group actually pays for the technology
• Post-assignment monitoring — recalibration, weight changes, and packaging exposure as the rules turn over each year

Best when: the code exists but the payment group doesn't fit — the case pays as if your technology weren't in the room.

Already have a draft — written in-house or by another firm? An independent review before you file is the cheapest insurance in this business. And for everything that isn't a filing, general consulting puts the firm's reimbursement judgment on call.

• Independent review of CPT, HCPCS, ICD-10, DRG, APC, NTAP, and pass-through applications before filing
• Findings ranked by severity — what a panel, workgroup, or committee will challenge, and how to fix it while there's still time
• Second opinions on code-path, descriptor, and payment-pathway decisions already made
• General reimbursement consulting: coding, coverage, and payment questions answered as they arise
• Reimbursement expertise for internal teams and diligence — the risk read on someone else's coding and payment claims

Best when: the application is drafted but unfiled, or you need senior reimbursement expertise without a full application engagement.

Senior reimbursement counsel on call — the questions that don't wait for a filing cycle, answered by senior practitioners who have filed, appealed, and collected on them.

• Ongoing senior counsel on coding, coverage, and payment questions as they arise
• A standing second read on payer policy changes, denial patterns, and coding guidance
• Direct access to senior advisors — no junior hand-offs, no call-center layers
• Scoped to the hours you'll actually use, with regular steering reviews

Best when: reimbursement questions land weekly and you want one senior answer, not a research project each time.

Reimbursement is where medtech and life-science valuations quietly succeed or fail. We give investors and acquirers the operator's read — before the term sheet, not after the write-down.

• Reimbursement diligence on medtech and life-science assets: code status, coverage posture, and payment reality
• The pathway read — what a code, NTAP, pass-through, or DRG assignment would actually require, and how long it takes
• Revenue-model stress test: whether the forecast's coding and payment assumptions survive contact with CMS policy
• Findings in writing, ranked by severity — the risks priced in, and the ones that aren't

Best when: you're evaluating an acquisition, an investment, or a portfolio company whose value depends on getting paid.

The plan above the filings: which codes, in which order, in which settings — set at portfolio and launch level, before individual applications are scoped.

• Portfolio-level coding, coverage, and payment strategy across products and indications
• Launch sequencing: code path, evidence plan, and pricing decisions ordered against the filing calendars
• Site-of-care and channel strategy — office, ASC, HOPD, and inpatient economics compared before you commit
• Board- and investor-ready reimbursement narratives grounded in the actual pathways

Best when: the decisions interact — multiple products, multiple settings, one launch window — and somebody has to hold the whole map.

Before you commit to a pathway, see the whole field. A landscape assessment maps how a product or category is actually coded, covered, and paid today — the competitors, the precedents, and the gaps your strategy has to be built on.

• Coding landscape: the codes in use across the category, who holds them, and where existing descriptors leave your product unserved
• Coverage landscape: LCDs, payer medical policies, and MolDx postures across Medicare and commercial payers — who pays, under what conditions, and who doesn't
• Payment landscape: rates by site of care (office, ASC, HOPD, inpatient), packaging exposure, and the supplemental pathways already in play
• Precedent landscape: granted and denied applications in and around your category — what reviewers accepted, what they rejected, and why
• Findings delivered as a written assessment: the map, the gaps, and the openings, ranked by what they mean for your filing and launch decisions

Best when: you're entering a category, sizing a market, or choosing a direction — and need the reimbursement terrain mapped before money is committed.

A landscape tells you where things stand; a strategic assessment tells you what to do about it. We take the evidence — your product, the landscape, the filing calendars — and turn it into a decision: options scored, trade-offs priced, and a recommendation you can defend in the room.

• Pathway options analysis: each viable code and payment route scored on probability, timing, payment outcome, and evidence cost
• Scenario and sensitivity modeling — what the plan looks like if the code is granted, packaged, delayed a cycle, or denied
• Sequencing and timing analysis against the filing calendars, FDA authorization, and launch window
• Risk-weighted recommendation in writing — the move we would make, the alternatives considered, and the conditions that would change the call
• Board- and investor-ready presentation of the analysis for teams that have to carry the decision upward

Best when: the options are real, the stakes are material, and the decision has to be made on analysis — not on whoever argues loudest.

Your application is finished — but is it ready? Before CMS sees it, a panel of former CMS reviewers drawn from the firm's expert bench reviews your completed application the way CMS will: independently, against the same criteria, and with the verdict and feedback delivered while there is still time to act on them.

• Panel of former CMS reviewers and senior specialists from the firm's network — each reviewer works independently, so you get separate reads, not one negotiated opinion
• A clear readiness verdict from each reviewer on the application as it stands: file it, fix it first, or rethink it
• Field-by-field findings across the whole application — descriptor, distinction evidence, existing-code analysis, billing units, and pricing — what holds, what doesn't, and why
• Prioritized remediation: every finding ranked by how much it moves the outcome, so the remaining window before your deadline goes to the fixes that matter
• Findings delivered as a written panel memorandum, with a walkthrough session for your team

Best when: the application is complete and the filing deadline is close — you want CMS's likely answer before CMS gives it.