This paper, the last of 3 that discuss the reimbursement challenges facing new medical device technology in various issues of this journal, addresses the structural diversity of Medicare's various payment systems. These systems vary widely in how they establish prices, how they incorporate new technologies and procedures, and the means by which they are updated and maintained. Their importance extends beyond Medicare because other payers use these payment rates as a basis for setting rates of their own. Device manufacturers and medical practitioners must often navigate several of these payment systems concurrently to ensure that technologies and procedures (that are already coded properly and covered) receive a fair payment rate. It is important to recognize that coverage can be undermined without adequate payment and that this situation will dampen further product innovation. The 3 papers, taken together, document the challenges posed by insurer reimbursement policies and show that a close working relationship between the manufacturers that develop new medical technologies and physician practitioners is needed if reimbursement hurdles are to be managed and medical innovation is to continue.