Ann: Response to ASX Price Query, page-52

  1. 332 Posts.
    lightbulb Created with Sketch. 48
    Great post IMO.

    It seems reasonable to go with a fresh application due to the timeframes for submission.

    Reconsideration: Would need to be submitted 30 May
    New application: Would need to be submitted 11 June

    Both would be considered at the September meeting, so why not take the extra time allowed by submitting a new application to shore it up. They now have actionable feedback which you would think would put them on a path to approval.

    The 5 general criteria are below. I'm not too concerned about that fact they failed two on first attempt. It's a new technology, so their application could be more scrutinised than usual as this will kind of 'set a precedent' for future codes.


    1. Unique and Well-Defined Descriptor


      • The code must have a clear, concise, and unambiguous descriptor that distinguishes it from all other CPT codes.

      • It must represent a distinct procedure, service, or technology.


    2. Consistency with CPT Editorial Standards


      • The structure, style, and terminology used in the descriptor and its guidelines must align with the current CPT Editorial Panel standards.


    3. Non-Fragmentation of Existing Services


      • The proposed code must not fragment an existing service already reported under a current CPT code.

      • It must not duplicate existing codes, unless there is a valid reason (e.g., novel method or context).


    4. Accurate Reflection of How the Procedure is Typically Performed


      • The descriptor should reflect the procedure or service as it is routinely delivered in clinical practice.

      • It should include any bundled or typically co-performed elements.


    5. Not for Extraordinary Circumstances


      • The code cannot be proposed solely to represent rare or unusual scenarios.

      • The service must have demonstrable clinical utility beyond one-off or exceptional uses.



 
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