| 340B | 340B Drug Pricing Program | Federal program providing discounted drugs to safety-net providers. |
| APC | Ambulatory Payment Classification | The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient. |
| BIM | Budget Impact Model | Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon. |
| CED | Coverage with Evidence Development | Medicare paradigm conditioning coverage on participation in approved clinical studies or registries. |
| CPTmore than one meaning | Current Procedural Terminology Codes | AMA-maintained codes used to report medical procedures and services for billing. |
| CPTmore than one meaning | CPT Codes | AMA-maintained codes that describe medical procedures and services. |
| DMEPOS | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies | Medicare benefit category covering durable medical equipment, prosthetics, orthotics, and supplies, billed under HCPCS Level II codes through DME MACs. |
| HCPCS | HCPCS Codes | CMS-maintained codes for products, supplies, and services not in CPT. |
| HEOR | Health Economics and Outcomes Research | Research discipline that generates economic, clinical, and patient-reported evidence to support payer access, HTA submissions, and value demonstration. |
| HTA | Health Technology Assessment | Systematic evaluation of clinical and economic value of a health technology. |
| ICER | Incremental Cost-Effectiveness Ratio | Cost per additional unit of health outcome (often QALY) versus comparator. |
| IPPS | Inpatient Prospective Payment System | Medicare's payment system for inpatient hospital stays. |
| JCA | Joint Clinical Assessment | EU-wide clinical assessment of high-risk medical devices and IVDs. |
| MAC | Medicare Administrative Contractor | Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions. |
| MPFS | Medicare Physician Fee Schedule | Medicare's payment system for physician professional services. |
| MS-DRG | MS-DRG | Medicare's inpatient hospital payment classification system. |
| NCD / LCD | National and Local Coverage Determinations | Medicare coverage policies issued nationally (NCD) or by individual MAC contractors (LCD). |
| NTAP | New Technology Add-On Payment | Supplemental Medicare payment for inpatient use of qualifying new technologies. |
| OPPS | Outpatient Prospective Payment System | Medicare's payment system for hospital outpatient services. |
| PAMA | Protecting Access to Medicare Act | Law that revised Medicare pricing for clinical lab services. |
| PLA | Proprietary Laboratory Analyses Codes | AMA CPT code subset that uniquely identifies a single proprietary clinical lab test (LDT or IVD) for pricing and tracking. |
| QALY | Quality-Adjusted Life Year | Outcome metric combining length and quality of life used in HTA. |
| RAC | Recovery Audit Contractor | CMS contractor that audits Medicare claims for improper payments. |
| TCET | Transitional Coverage for Emerging Technologies | CMS pathway providing time-limited Medicare coverage for FDA-designated Breakthrough Devices. |
| TPT | Transitional Pass-Through Payment | Supplemental outpatient payment for new device technologies. |
| VBC | Value-Based Care | Payment tied to outcomes and total cost of care, not volume of services. |