You may recall previous posts about Medicare’s potential coverage of the artificial spinal disk Charite. As late as February, the Centers for Medicare and Medicaid (CMS) wanted to deny coverage for the surgery. CMS allowed a 30-day comment period, and at the time, the chances of coverage didn’t look promising.
According to Johnson & Johnson, the company that manufactures the disk, Medicare will allow its local medical directors to approve coverage for beneficiaries under 60. From the New York Times article cited by Medical News Today:
J&J, through its DePuy unit, is the only device maker with an artificial disc on the U.S. market after gaining approval to sell its product, called Charite, in October 2004.
Doctors have been slow to embrace the product, however, after the Medicare federal health insurance program last year denied J&J’s request to provide national coverage for it…J&J on Tuesday said Medicare agreed to allow its local medical directors to approve paying for the device in beneficiaries under the age of 60, a decision the company believes will open the door to better coverage among private insurers.
CMS previously denied coverage because clinical trial data failed to show the surgery to implant the disk was “reasonable and necessary.” The article doesn’t explain why CMS had a change of heart, and CMS has not issued a statement on this matter.