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CPT Code Application and LCD Reconsideration Request

CPT code application and LCD reconsideration planning that counts each study the way the Panel counts it and the way each Medicare contractor counts it, slides any deadline the evidence cannot meet, and leaves every replan and filing to named people.

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Follow the registry that was only an abstract ↓

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The problem

The study you counted on is an abstract, weeks before the deadline

A new procedure needs two separate yeses before most doctors are paid for it: a permanent code from the Panel, and coverage from each Medicare contractor whose policy still calls it investigational. Each reviewer reads the same studies by its own rule. A study that counts for one may not count for the other.

Today the evidence summary is rebuilt by hand for each packet, often by an outside consultancy. The team learns that a registry was only a conference abstract, or that a trial sits in the contractor's bibliography already, after the date has gone. Meanwhile a draft sentence that claims more than the cleared use is on its way out of the building.

Built forReimbursement directorsHealth economics leadsMedical affairs leadsCompliance reviewers

The Problem Today

Two reviewers count the same studies by different rules, and a missing study shows up after the deadline has passed.

250: Hours per coding or coverage packet, mostly built by hand our estimate

Done by hand today

Studies
Criteria
Deadlines
Drafts

Each reviewer counts apartA study can count for one and not the other
Claims slip into draftsOne sentence past the cleared use is a finding

The Solution

Each study, two verdictsSorted by the Panel's rule and the contractor's rule, passage cited
Gaps named, never filledThe draft states the missing study in plain words, never a claim
The block slides firstA deadline the evidence cannot make moves, with what depends on it
People sign each moveDirector accepts, medical affairs approves, compliance clears

Built-in controls

Agents never file, sign or move a signed date
A clinical question gets a named person, not an answer
No one signs what they prepared

What You Get

The director signs a plan the evidence can actually meet, and coverage requests file on their own date.

Fixed dates in one viewPanel, valuation, fee schedule and contractor dates together
Drafts that cite what countsApplication, request and summary cite eligible studies only
A record ready for auditWho acted, when, why, and the meaning of each signature

Nineteen days before the deadline

A CPT code application for a mapping add-on, and the deadline it cannot make

A mapping catheter's add-on procedure runs on a temporary code. The plan on the calendar files the permanent code application and three coverage requests on the same day, 19 days from now.

demoSample data: the company, its catheter, each study, each person and each date.

0109:00
The registry's letter came yesterday; the plan predates it
Health economics manager
The calendar puts dates nobody at the company controls in the top rows: Panel meetings with their deadlines, valuation meetings, fee schedule rules and contractor clocks. The team's own work sits below. A note says the registry's acceptance letter came in, and the plan has not been checked against it.
0209:14
1 of 2 US studies counted for the Panel; the registry is still an abstract
Health economics manager
He sorts the evidence and the agents run beside the calendar. Under the Panel rule the team loaded, it takes two full-text US studies with distinct patients. Only the randomized trial counts. The follow-up shares its patients, and the 1,184-patient registry is a conference abstract until it prints. For the contractors, three studies are new since their policy.
0309:20
Two verdicts on one registry, each tied to a page
Reimbursement director
The study page shows what the agents quoted: an abstract with 1,184 adults at 38 US centers, and an acceptance letter saying the print issue comes later. Against the Panel rule it fails on published in full. Against the contractor rule it fails on a full-text copy. Either verdict can be challenged, with a reason.
0409:26
What moves: the code application, the society letters and the valuation survey
Reimbursement director
The health economics manager sends the replan, and the director opens what moves before she can decide. The application slides to the last Panel meeting of the cycle, with no slack left. Society letters and the valuation survey slide with it. The coverage requests stay on their date, because they do not lean on the registry.
0509:32
She accepts the later date with a reason and her own password
Reimbursement director
Her reason is plain: the evidence cannot make the earlier deadline. The signature means she approves the change to the filing dates. The calendar now shows the application on the later deadline with a refresh planned for when the registry prints, and a ghost block for the extension request if that date slips too.
0609:46
Five sections opened before the evidence summary is approved
Medical affairs lead
The medical affairs lead opens each section in turn: the procedure and its cleared use, what counts for the Panel, what is new to the contractors, safety, and what was not counted and why. Safety is a signed input from her own team that the agents do not read. Only then can she approve it.
0710:00
Seven flagged sentences, and a sample of 8 of the 79 quoted ones
Compliance reviewer
Each draft sentence was checked against the cleared indications. One overstates a trial's result, one calls a cleared catheter approved, one stretches to all ages. Each comes with a suggested rewrite and its source. The quoted sentences are signed by a sample, each opened against its source first.
0810:10
Three coverage requests, one per jurisdiction, waiting on compliance to file
Reimbursement director
The request names the sentence to delete, the language to add and the three new studies. Each jurisdiction gets its own letter and its own 60-day validity clock once filed. Filing stays locked until the flagged sentences are cleared and the sample is signed.

Fourteen studies, and why only one counts for the Panel

The same library, sorted by two rules. A study can fail one and pass the other.

Study	Panel	Coverage requests
Randomized trial, 412 US patients	Counts	Already in the bibliography
Its 24-month follow-up	Same patients	New
Registry, 1,184 US patients	Abstract only	Abstract only
Randomized trial, 260 patients outside the US	Not US patients	New
Older-adult cohort, 318 patients	Not US patients	New
Pediatric case series	Outside the cleared use	Excluded

demoSample data, from the working solution. The other eight are a sub-analysis, a feasibility study, bench data, a review, a poster, an editorial, a preprint and a budget model.

Around the packet

The library, the gaps and twenty packets behind each CPT code application

What the health economics team, compliance and the director look at between filings.

Evidence library of fourteen studies with separate verdict columns for the Panel and the coverage requests — **14 studies**The evidence library with a column per reviewer: counts for the Panel, new to the contractors, not counted, excluded.

Gaps per criterion for the Category I application and the coverage requests, each with an owner and a due date — **Gaps**Each criterion as met, gap or a person decides, with an owner and a date. The drafts state each gap plainly.

Category I application draft on hold, with the proposed code descriptor, clinical vignette and a person-written section — **Category I draft**The 98-sentence application on hold until the registry prints. The section on existing codes is written by a person.

List of twenty coding and coverage packets with owner, stage, next fixed date and whether each is on time — **20 packets**Each coding and coverage packet this year with its owner, stage, next fixed date and clock: on time, at risk or replanned.

Decision queue by person with business-day clocks for compliance items and the log of decisions with reasons — **Who waits on whom**Each person's open items with a business-day clock, and the decision log with the reason kept beside each decision.

Audit trail with sections read, the accepted replan and the approved evidence summary, each with signature meaning and session — **Audit trail**Each read, acceptance and approval, with who made it, what the signature means and the session. Exports as a spreadsheet or data file.

demoSample data, from the working solution.

Who counts the evidence

Seven agents count the evidence; filing and signing stay with people

They read, sort, check, plan and draft. People decide each date and each sentence.

Evidence intake

Reads each study's design, patients, sites, publication type and dates, each cited.

Never reads complaint, adverse event or surveillance records
Never adds a study without its source file

Panel criteria sorter

Sorts each study by the loaded Category I rule, quoting the deciding passage.

Only counts; never judges how widely the procedure is performed

Coverage evidence checker

Compares each study with each jurisdiction's bibliography and checks the full text is on file.

Never decides whether evidence would change the policy

On-label checker

Checks each study and draft sentence against the cleared indications.

Never approves a sentence
Never rewrites the safety section

Cycle planner

Loads fixed dates and slides blocks the evidence cannot make, with the knock-on.

Never moves a signed date or files anything

Application drafter

Drafts the application, the request and the summary, citing only studies that count.

Never fills a gap with a claim

Outside event watcher

Watches the registry's print date, the Panel agenda and each contractor's postings.

Proposes changes; never makes them

Who proposes, who decides and who clears each sentence

The person who prepares an item never signs it.

Health economics manager

Sees: The library, the verdicts and the calendar
Signs: Proposes replans and edits drafts; signs neither

Reimbursement director

Sees: What moves, and each request before filing
Signs: Each replan and each filing

Medical affairs lead

Sees: Each section of the evidence summary, opened
Signs: Scientific accuracy; owns the safety section

Compliance reviewer

Sees: Flagged sentences and a sample of quoted ones
Signs: Clears sentences within the cleared use

Specialty society liaison

Sees: What is shared with the society
Signs: Nothing; reads only

What reimbursement teams ask about a CPT code application

What does a CPT code application involve?

A CPT code application asks the Panel for a code for a procedure, with a descriptor, a clinical vignette and the literature behind it. Here the evidence is counted first by the Panel's literature rule, so the team knows which meeting it can make before drafting for one.

Why count each study twice?

Each contractor for Medicare and the Panel ask different questions of the same studies. Under the Panel rule your team loads, it takes full-text US studies with distinct patients; a contractor wants evidence that is new since its policy. One study can pass one and fail the other.

Does it move our filing dates on its own?

No. The cycle planner proposes the slide and shows what moves with it. The health economics manager sends the replan, and the reimbursement director accepts or declines it with a reason.

How are off-label claims kept out of the drafts?

The on-label checker reads each draft sentence against the cleared indications and flags any that go further. A compliance reviewer clears the flagged ones and signs a sample of the rest after opening each against its source.

Does it read safety or adverse event data?

No. The safety section of the evidence summary arrives as a signed input from medical affairs, and drafts refer to it by number. Complaint, adverse event and surveillance records are never read.

Where do the Panel's rules come from?

From the application instructions your team loads, kept as a document with its version. The rule shown in settings is the one loaded, and a new version takes two signatures.

Market Access & Reimbursement

Send us your evidence library
and the coverage policy you need changed.

We will count each study by both rules and show which deadline it can make.

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CPT Code Application and LCD Reconsideration Request

The study you counted on is an abstract, weeks before the deadline

The Problem Today

The Solution

What You Get

A CPT code application for a mapping add-on, and the deadline it cannot make

The registry's letter came yesterday; the plan predates it

1 of 2 US studies counted for the Panel; the registry is still an abstract

Two verdicts on one registry, each tied to a page

What moves: the code application, the society letters and the valuation survey

She accepts the later date with a reason and her own password

Five sections opened before the evidence summary is approved

Seven flagged sentences, and a sample of 8 of the 79 quoted ones

Three coverage requests, one per jurisdiction, waiting on compliance to file