HR1931-119

What This Bill Does

The Access to Pediatric Technologies Act creates a Medicare payment pathway for qualifying pediatric technologies that lack national relative value units under the physician fee schedule. Starting with technologies furnished on or after January 1, 2026, the HHS Secretary must establish RVUs when a manufacturer requests them and supplies information verifying pediatric eligibility and supporting payment valuation. The Secretary must use the physician fee schedule methodology and available data such as contractor pricing, claims, time-and-motion studies, invoices, and other rate-setting information. Requests received on or before May 1 must be handled in that year's physician fee schedule rulemaking; later requests move to the following year's process. Qualifying devices must be Medicare-covered, FDA approved, cleared, or authorized, described by a temporary Level I HCPCS code for emerging technologies, services, or procedures, and predominantly used in pediatric procedures or specifically designed for safe and effective pediatric use. The bill does not itself require Medicare coverage or change medical-necessity rules.

Who Benefits and How

Pediatric medical device manufacturers benefit from a defined process to obtain national RVUs for emerging pediatric technologies. Children needing specialized procedures benefit if national payment values make pediatric technologies easier for clinicians to furnish. Pediatric specialists benefit from more predictable Medicare physician fee schedule valuation for qualifying devices and procedures. Hospitals and outpatient practices benefit when national RVUs replace inconsistent contractor pricing for pediatric technologies.

Who Bears the Burden and How

CMS must evaluate manufacturer requests, verify qualifying pediatric technology status, and establish RVUs through annual rulemaking. Manufacturers must submit pricing, claims, time-and-motion, invoice, or other relevant data to support valuation. Medicare contractors must adjust payment systems once national RVUs are established. Federal taxpayers and Medicare may face higher spending when national payment values increase access to qualifying technologies.

Key Provisions

• Requires Medicare to establish national RVUs for qualifying pediatric technologies upon manufacturer request.
• Applies to qualifying pediatric technologies furnished on or after January 1, 2026.
• Creates May 1 timing rules for same-year or following-year physician fee schedule rulemaking.
• Limits qualifying technologies to covered, FDA-authorized, temporary-HCPCS pediatric devices without changing coverage or medical-necessity rules.