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Access to Pediatric Technologies Act of 2025
3/24/2025, 1:23 PM
Summary of Bill HR 1931
Specifically, the bill seeks to address the challenges that pediatric patients face in obtaining access to medical devices that are not traditionally covered by Medicare. These devices may include specialized equipment for children with disabilities or chronic conditions, such as wheelchairs, prosthetics, or communication devices.
The proposed amendments would establish a process for healthcare providers to request coverage for pediatric devices that are not currently covered by Medicare. This process would involve submitting documentation to demonstrate the medical necessity of the device for the individual patient. Additionally, the bill aims to improve coordination between Medicare and other insurance providers to ensure that pediatric patients have access to the devices they need. This would help to alleviate the financial burden on families who may struggle to afford these specialized devices out of pocket. Overall, the Pediatric Device Access Act is designed to make it easier for pediatric patients to access the medical technologies they need to thrive and improve their quality of life. By streamlining the coverage process and improving coordination between insurance providers, the bill aims to ensure that children have access to the care they need to reach their full potential.
Congressional Summary of HR 1931
Access to Pediatric Technologies Act of 2025
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish, upon request, specific payment methodologies for qualifying pediatric technologies under the Medicare physician fee schedule. Qualifying pediatric technologies are medical devices that are (1) covered under Medicare, (2) approved by the Food and Drug Administration, (3) currently billed using a specified temporary billing code for emerging technologies, and (4) predominantly used or specifically designated for pediatric patients.
The CMS must develop a payment methodology for a qualifying pediatric technology upon request from the manufacturer and based on available data, including pricing information and claims data. Manufacturers must include relevant information in their requests to enable the CMS to develop the corresponding methodologies.





