Victoria M. Wallace

Victoria has significant experience applying for and obtaining Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes.  She successfully secures special payment status under the Medicare Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), and Physician Fee Schedule (PFS), including New Technology Add-on Payment (NTAP), New Technology Ambulatory Payment Classification (APC), and drug and device pass-through payment.  She advises clients seeking coverage and payment under the Medicare Durable Medical Equipment, Prosthetic, Orthotic, and Supplies (DMEPOS) benefit category, including for digital health manufacturers.  She regularly facilitates meetings with the Centers for Medicare & Medicaid Services (CMS) on behalf of clients who face reimbursement challenges that need to be brought to the Agency’s attention for resolution.

She works withclinical laboratories and  developers of sophisticated diagnostic tests to secure Proprietary Laboratory Analysis (PLA) codes, navigate coverage with MolDx, and ensure compliance with the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

Underlying all this work is Victoria’s dedication to understanding the ins and outs of reimbursement pathways and turning them into actionable strategies for clients.  When problems arise, Victoria leans into this knowledge to solve issues and develop innovative solutions.