New Law Mandates Medicare Payment Rates for Pediatric Tech by 2026: What It Means for Kids’ Healthcare

The “Access to Pediatric Technologies Act of 2025” tackles a very specific, but critical, problem in healthcare: making sure that new medical tools designed just for kids actually get paid for. Starting January 1, 2026, this bill creates a mandatory process where Medicare must set national payment rates (called Relative Value Units, or RVUs) for “qualifying pediatric technologies” that are already covered by Medicare but lack a specific payment rate under the physician fee schedule. Think of this as putting a clear price tag on specialized equipment, like a new type of tiny heart valve or an advanced monitoring system designed specifically for infants, which previously might have been paid for inconsistently or not at all.

The Data Trail: How Manufacturers Get Paid

This isn't a free pass for manufacturers. To get these rates set, a medical device company has to submit a formal request to the Secretary of Health and Human Services. Crucially, they must back up their request with hard data—everything from pricing and claims records to time studies and invoice details. The Secretary then uses this information to calculate the official RVUs, which determine how much doctors get paid for using the technology. If a manufacturer gets their paperwork in by May 1st, the payment rate must be established during that same year’s annual Medicare rulemaking. Miss the deadline, and they have to wait until the following year. It’s a tight schedule designed to ensure new tech doesn't languish in payment limbo.

Why This Matters for Parents and Providers

For a parent, this bill is about access. Developing specialized medical devices for children is often less profitable than developing devices for adults because the patient population is smaller. If manufacturers can’t be sure doctors will be reimbursed consistently for using their product, they simply won't invest in developing it. This bill removes that uncertainty, creating a clear, predictable path to payment. This should encourage innovation, leading to more, and better, specialized tools for pediatric care. For doctors, it means they won't have to jump through hoops or take a loss when using the best, newest technology on their young patients.

Keeping the Guardrails Up

It’s important to note what this bill doesn't do. It doesn't change what Medicare covers. This process only applies to technologies that Medicare already deems medically necessary and covers under existing rules (Section 1862(a)(1)(A)). If Medicare wasn't covering a procedure or device before, this bill won't force them to start. It only fixes the payment rate for things already on the roster. The main challenge here is making sure the RVUs are set fairly. Since the Secretary relies on data provided by the manufacturer—data on pricing, time studies, etc.—there is some built-in risk that the initial rates could be inflated, potentially leading to higher costs for the Medicare system and, ultimately, taxpayers. However, the requirement to use standard payment methods and available data should, in theory, keep the calculation grounded in reality.