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July 3, 2018

Post Market Studies and Post Market Extension Studies

Post Market Studies

Coverage and reimbursement for specific "post-marketing studies" may be approved by Medicare contractors. These studies all involve the use of percutaneous transluminal angioplasty (PTA) with carotid stenting and embolic protection.

Providers must submit an application for approval that includes the following:

  1. CGS Submission Form
  2. FDA acknowledgement letter with assigned "P" number;
  3. IRB approval
  4. Patient Consent form

Post Market Extension Studies

CMS issued instructions on October 12, 2004, for processing claims for carotid artery stenting procedures performed as part of a Food and Drug Administration (FDA) approved post-approval studies, such as CAPTURE. As the post-approval studies began to come to an end, CMS reviewed extension requests and determined that contactors may grant coverage approval for extension studies if providers complete the defined steps.

Providers must submit the following to CGS:

  1. CGS Submission Form
  2. The FDA acknowledgement letter and the original Post-Market Approval (PMA) number from the original FDA post-approval study
  3. The CMS letter providing coverage for the extension study
  4. IRB approval
  5. The Patient Consent form.

All of the above items must be received prior to review and coverage determination. This information must be submitted to J15IDE@cgsadmin.com

After receiving this required information, CGS will issue a letter to the provider assigning an effective date for coverage. Providers may bill for procedures performed in the post-marketing or the post-marketing extension study for dates of service on or after the assigned effective date. Providers must bill in accordance to CMS regulations for these studies.

References

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