CMS Medicare Learning Network (MLN)

Published 01/01/2020

We encourage you to visit the Medicare Learning Network® (MLN), your source for official CMS Medicare fee-for-service (FFS) provider educational information. Get quick access to MLN Matters national provider education articles that help you understand new or revised Medicare policy and other educational products.

  • MLN Matters Articles: These articles explain national Medicare policy in an easy-to-understand format
  • MLN Publications: These educational resources explain topics such as coding, preventive services, and provider compliance
  • MLN Calls & Webcasts: These events, presented by CMS experts, cover changes to the Medicare program.
  • MLN Provider Compliance: Learn how to avoid common errors with these educational resources

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Section 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicareInpatient Rehabilitation Facility (IRF) Medical Review ChangesProhibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramActivation of Systematic Validation Edits for OPPS Providers with Multiple Service LocationsNotifying Medicare Patients about Lifetime Reserve Days (LRDs)Medicare Continues to Modernize Payment SoftwareReview of Hospital Compliance with Medicare's Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status CodesActivation of Systematic Validation Edits for OPPS Providers with Multiple Service LocationsUpdate to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2021 - Recurring File UpdateProper Use of Modifier 59Intensity-Modulated Radiation Therapy (IMRT) Planning Services EditingSkilled Nursing Facility Value-Based Purchasing Program UpdatedMedicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other FacilitiesBilling Requirements for OPPS Providers with Multiple Service LocationsIncreasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked QuestionsImplementation of Two New NUBC Condition Codes. Condition Code "90", "Service Provided as Part of an Expanded Access Approval (EA)" and Condition Code "91", "Service Provided as Part of an Emergency Use Authorization (EUA)"Medicare Cost Report E-Filing (MCReF)Next Generation Accountable Care Organization - ImplementationNew Medicare Webpage on Patient Driven Payment ModelUpdate to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2021Rural Health Clinics (RHCs) Healthcare Common Procedure Coding System (HCPCS) Reporting Requirement and Billing UpdatesNew Electronic System for Provider Reimbursement Review Board AppealsNCD 20.4 Implantable Cardiac Defibrillators (ICDs)Medicare Plans to Modernize Payment Grouping and Code Editor SoftwareMedicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingTotal Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight RuleReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesAccepting Payment from Patients with a Medicare Set-Aside ArrangementA Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized IndividualsBilling for Services when Medicare is a Secondary PayerNew Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES ActEmergency Medical Treatment and Labor Act (EMTALA) and the Born-Alive Infant Protection ActLocal Coverage Determinations (LCDs)Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsReminder on Billing Requirements Implemented for non-OPPS ProvidersFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsMedicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentCertifying Patients for the Medicare Home Health BenefitNew Medicare Beneficiary Identifier (MBI) Get It, Use ItRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)Update to Rural Health Clinic (RHC) Payment LimitsWaiver of Coinsurance and Deductible for Hepatitis B Preventive Service Vaccine Code, Section 4104 of the Patient Protection and Affordable Health Care Act (the Affordable Care Act), Removal of Barriers to Preventive Services in MedicareMLN Connects for Thursday, May 13, 2021MLN Connects Special Edition - Thursday, July 1, 2021MLN Connects Special Edition: Monday, August 2, 2021Internet Only Manual Updates to Publication (Pub.) 100-02 to Implement Updates to Policy and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF))Update of Internet Only Manual (IOM), Pub. 100-04, Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician-Supplier ClaimsInternet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2022Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2022Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Health Care (CAQH) COREMedicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)Annual Clotting Factor Furnishing Fee Update 20222022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentClaims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve RegurgitationInfluenza Vaccine Payment Allowances - Annual Update for 2021-2022 SeasonQuarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)October 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.3October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleOctober 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - January 2022Medicare Clarifies Recognition of Interstate License Compacts PathwaysInpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2022January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesChanges to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022Claim Status Category and Claim Status Codes UpdateNational Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell TherapyFiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS ChangesApril 2022 Update to the Java Medicare Code Editor (MCE) for New Edit 20 - Unspecified Code EditInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 2 of 2)MLN Connects for Thursday, November 4, 2021Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationSkilled Nursing Facility (SNF) Claims Processing Updates2022 Annual Update of Per-Beneficiary Threshold Amounts2022 Annual Update to the Therapy Code ListImplementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2022The Supplemental Security Income (SSI) and Medicare Beneficiary Data for Fiscal Year (FY) 2019 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateSkilled Nursing Care and Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: ReminderReduced Payment for Physical Therapy and Occupational Therapy Services Furnished in Whole or In Part by a Physical Therapist Assistant or an Occupational Therapy AssistantUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2022Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08Calendar Year 2022 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSummary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services ListJanuary 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) Section 240.6Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022Skin Substitute CodesCalendar Year (CY) 2022 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentImplementation of the GV Modifier for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for Billing Hospice Attending Physician ServicesInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 1 of 2)Skilled Nursing Facility (SNF) Claims Processing Update to Fiscal Year End (FYE) EditsStandard Elements for DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization RequirementsNew and Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHEExpedited Review Process for Hospital Inpatients in Original MedicareClinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of SpecimensQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentNational Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsApril 2022 Update to the Medicare Severity - Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 39.1 for the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019 Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding System (PCS) Codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 TreatmentQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2022 UpdateThe Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year (FY) 2020 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)Internet-Only Manual Updates for Critical Care Evaluation and Management ServicesInternet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician AssistantsApril 2022 Update to the Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS)April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleApril 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateClaims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20-valent Conjugate Vaccine Code 90677Unsolicited Voluntary RefundsUpdate to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General UpdatesCWF Editing - National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - July 2022Section 127 of the Consolidated Appropriations Act: Graduate Medical Education (GME) Payment for Rural Track Programs (RTPs)Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter As Certain Colorectal Cancer Screening TestsUpdate of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 - AmbulanceCalendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationNational Coverage Determination (NCD) 210.14 Reconsideration - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)MLN Connects for Thursday, May 5, 2022Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentMLN Connects for Thursday, May 12, 2022MLN Connects for Thursday, May 19, 2022MLN Connects for Thursday, May 26, 2022Update to the Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2022An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of CoverageQuarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)MLN Connects for Thursday, June 2, 2022Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2MLN Connects for Thursday, June 9, 2022Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023July Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleMental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health CentersMLN Connects for Thursday, June 16, 2022July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)MLN Connects Special Edition: Tuesday June 21, 2022International Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs)-October 2022International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021MLN Connects for Thursday, June 23, 2022Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateChanges to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022MLN Connects for Thursday, June 30, 2022MLN Connects for Thursday, July 7, 2022MLN Connects Special Edition: Thursday, July 7, 2022MLN Connects for Thursday, July 14, 2022MLN Connects Special Edition for Friday, July 15, 2022MLN Connects for Thursday, July 21, 2022MLN Connects Special Edition for Wednesday, July 27, 2022MLN Connects for Thursday, July 28, 2022MLN Connects Special Edition: Friday, July 29, 2022MLN Connects Special Edition: Monday, August 1, 2022Implementation of the Capital Related Assets (CRA) Adjustment for the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Under the End Stage Renal Disease Prospective Payment System (ESRD PPS)MLN Connects for Thursday, August 4, 2022