June 16, 2026
EW: TAVR Draft Coverage Puts & Takes
CMS’s draft coverage policy for transcatheter aortic valve replacement (TAVR) appears largely consistent with our initial expectations, likely bringing some incremental upside as well. If finalized largely as proposed in Sept., as seems probable, we…
June 11, 2026
[EW, MDT, ABT] TAVR: Incremental Gains From Expected Coverage
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…
June 10, 2026
GKOS iDose: MAC Pushback Persists
We see little reason to alter our base case regarding Medicare coverage of GKOS’s iDose following yesterday’s first contractor open meeting on the five-MAC draft LCD issued in late May. While we believe the MACs…
June 3, 2026
DXCM: What to Expect When You’re Expecting CGM Coverage
In advance of Dexcom’s (DXCM) readout of its CONNECT RCT this weekend, which management positions as a “powerful anchor” for broader Medicare CGM coverage in “all people with diabetes,” we ultimately expect a material increase…
May 28, 2026
INSP: Noridian’s Modifier & Service Date Inconsistencies
With Noridian (17% of services) including instructions that physicians bill for Inspire Medical’s (INSP) Inspire V procedure with a -52 (reduced work / payment) modifier this morning, following a similar update from WPS on May…
May 26, 2026
GKOS: iDose LCD & Laser Headwinds
Following last week’s draft LCDs requiring Glaukos (GKOS) iDose patients to first fail ≥ 2 topical medications and selective laser trabeculoplasty (SLT), the absence of reliable data on the proportion of existing patients that can…
May 21, 2026
GKOS: iDose Coverage & Second Line Therapy
The draft local coverage decision (LCD) issued today by five MACs with jurisdiction over ~70% of Glaukos (GKOS) Medicare FFS volumes is both better and worse than we had anticipated for the company’s growing iDose…
May 15, 2026
INSP: New Code Denial & Implications
With today’s rejection of INSP’s coding application for the Inspire V device by the AMA, the company’s last opportunity to have a new code take effect by Jan. 1, 2028 will be to secure approval…
May 7, 2026
iRhythm (IRTC): Final LCD Signals Relief, Modest Headwind
We suspect iRhythm (IRTC) faces both relief and little more than a modest growth headwind following a finalized local coverage determination (LCD) from its primary Medicare Administrative Contractor (MAC) this morning. In keeping with expectations…
May 7, 2026
INSP: MAC Modifier Mandate
Medicare Administrative Contractor (WPS) WPS – with jurisdiction over ~13% of INSP implants – this morning updated its hypoglossal nerve LCD billing article to instruct physicians to bill for Inspire V services with a -52…