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Despite recent speculation that Medicare Administrative Contractors (MACs) may not pursue a formal coverage policy for GKOS iDose procedures, we continue to expect a draft local coverage determination (LCD) in Q2 / Q3. Following the…

With Medicaid insurers [MOH, CNC, ELV] projecting more muted Medicaid enrollment changes for 2026 compared with the sizable attrition during the post-pandemic Medicaid unwinding – and little guidance on what comes next – investors are…

With Congress partially out of session this week, Washington will continue to revolve around the Iran conflict, trade policy adjustments, and a handful of legislative initiatives moving through the Senate. The Senate remains in session while the…

Following FDA approval of LNTH’s Pylarify TruVu late Friday, we continue to expect CMS to provide a three-year transitional pass-through (TPT) payment for hospital outpatient services effective Oct. 1, 2026, with our best estimate on…

As we had anticipated, the American Medical Association’s (AMA) CPT Editorial Panel will evaluate the creation of a new reimbursement code to describe single lead hypoglossal nerve neurostimulation (HGNS) devices (e.g., INSP’s Inspire V) at…

CMS’s warning letter against ELV of potential sanctions on new Medicare Advantage (MA) enrollment underscores another enforcement lever the agency can deploy to curb improper risk adjustment behaviors and overpayments. As the agency remains committed…

With the Congress back in Washington this week, Iran will dominate the agenda, but it won’t completely crowd out housing policy, Department of Homeland Security (DHS) funding, and Farm Bill politics.  The House and Senate are both expected to move an Iran-related war powers resolution this week; however, it is unlikely to constrain the…

We see little practical reimbursement impact for INSP from CMS’s announcement this morning that it will be creating a set of new facility level C-codes for newer generation hypoglossal nerve stimulation (HGNS) device services (e.g.,…

Trade policy is likely to remain fluid in the months ahead as the Trump administration invokes Sections 122, 232, 301, and potentially 338 authorities. While the threat of Section 122-based tariffs provides near-term leverage to push for bilateral trade agreements, the statutory 150-day limit of…

In advance of the CMS draft coverage decision for transcatheter aortic valve replacement (TAVR) due June 15 (final Sept. 15), we expect policy changes that – while positive – may be more incremental in their…