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Medicare Coverage Determination Process

Post Coverage Analysis

The Coverage and Analysis Group of the Office of Clinical Standards and Quality is responsible for making national coverage decisions (NCDs). Many of these decisions have the potential to significantly affect the Medicare program and Medicare beneficiaries, particularly those that involve major benefit expansions. Evaluations of the effect of coverage on patient outcomes, clinical practice, and health care costs can make considerable contributions to the medical evidence, and may affect future coverage policy and clinical management.

Medicare claims data contain a wealth of information about clinical outcomes and Medicare expenditures in Part A and B claims. New item or service can be identified using HCPCS and CPT codes. Post coverage analyses can be descriptive, evaluating patients' characteristic and diffusion of the technology. Longitudinal studies using the data can follow patients after treatment for months or years. Pre-coverage claims can be used to evaluate changes in outcomes and to develop risk adjusters. Comparison groups can be developed using claims data using a number of statistical techniques allowing controlled observational studies. Researchers interested in access Medicare claims data should contact the Research Data Assistance Center (ResDAC).

The post coverage analysis reports posted on this website are for scientific and clinical interest. Opinions and conclusions in the reports are those of the authors and do not reflect positions or policies of the Centers for Medicare & Medicaid Services.


Post Coverage Analysis: Use of Positron Emission Tomography (PET) Scans: Final Report [PDF, 1MB]

Post Coverage Analysis of Transmyocardial Revascularization among Medicare Beneficiaries (TMR): Final Report [PDF, 872KB]

Post Coverage Analysis of the Outcomes Following Surgical Treatments among Elderly Medicare Men with Benign Prostatic Hypertrophy [PDF, 1MB]
Related Links Inside CMS
Coverage Center

Medicare Coverage Database
Related Links Outside CMS

Research Data Assistance Center (ResDAC)



Page Last Modified: 05/27/2008 7:41:41 AM
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