Clinical Research and Clinical Trial Professional and Technical Fee Billing: Difference between revisions

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Only qualified clinical trials are eligible for reimbursement for routine costs under Medicare. In order to be a qualified trial, the trial must meet three mandatory criteria and have other desirable characteristics '''(see Medicare Qualifying Clinical Trials Flowchart).'''  
Only qualified clinical trials are eligible for reimbursement for routine costs under Medicare. In order to be a qualified trial, the trial must meet three mandatory criteria and have other desirable characteristics '''(see Medicare Qualifying Clinical Trials Flowchart).'''  


The ''three mandatory criteria'' are:         
The three mandatory criteria are:         
*Trial evaluates an item or service that falls within a Medicare benefit category (e.g. physicians' service, durable medical equipment, diagnostic test) that is not statutorily excluded from coverage (e.g. cosmetic surgery, hearing aids);
*Trial evaluates an item or service that falls within a Medicare benefit category (e.g. physicians' service, durable medical equipment, diagnostic test) that is not statutorily excluded from coverage (e.g. cosmetic surgery, hearing aids);
*Trial has therapeutic intent.  
*Trial has therapeutic intent.