Medicare News


Medicare News includes information for health care professionals about Medicare programs, policies and initiatives. Use these resources to stay up-to-date about current and planned Medicare changes.

Palmetto GBA maintains links to recently released and revised Centers of Medicare & Medicaid Services (CMS) MLN® articles. All MLN Matters articles will continue to be available on the CMS MLN Matters website. MLN Connects® will contain Medicare related messages from CMS. These messages ensure planned, coordinated messages are delivered timely about Medicare related topics.




ADR Response CalculatorJune 2020 JM Part A Medicare AdvisoryPeriodic Interim Payments (PIP) and Pass-Through Payment One-Day DelayNovember 2020 JM Part A Medicare AdvisoryDecember 2020 JM Part A Medicare AdvisoryOctober 2020 JM Part A Medicare AdvisoryMarch 2018 JM Part A Medicare AdvisoryJuly 2020 JM Part A Medicare AdvisorySeptember 2020 JM Part A Medicare AdvisoryAugust 2020 JM Part A Medicare AdvisoryNew Medicare Webpage on Patient Driven Payment ModelMedicare Continues to Modernize Payment SoftwareSection 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicareAdditional Documentation Requests (ADRs) Can Be ConfusingMedicare Cost Report E-Filing (MCReF)Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked QuestionsWritten Inquiries sent to Palmetto GBAActivation of Systematic Validation Edits for OPPS Providers with Multiple Service LocationsUpdate Inpatient Prospective Payment System (IPPS) Pricer and Related Claims ReprocessingCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersDid You Know Putting Condition Code D9 on Your Claim Will Cause it to Suspend?Intensity-Modulated Radiation Therapy (IMRT) Planning Services EditingBilling Requirements for OPPS Providers with Multiple Service LocationsSkilled Nursing Facility Value-Based Purchasing Program UpdatedNotifying Medicare Patients about Lifetime Reserve Days (LRDs)Activation of Systematic Validation Edits for OPPS Providers with Multiple Service LocationsUpdate to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2021Reading An Institutional Remittance Advice (RA)Proper Use of Modifier 59Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other FacilitiesImplementation 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)"Palmetto GBA B Notice or 1099 Request FormProhibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramMedically Unlikely Edits (MUEs) for Pressurized or Non-pressurized Inhalation TreatmentMedically Unlikely Edits (MUE) and Bilateral Surgical ProceduresMedically Unlikely Edits (MUEs) ReminderUpdate to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2021 - Recurring File UpdateNew Electronic System for Provider Reimbursement Review Board AppealsHow often does CMS update the Medicare Revalidation List due date information?Review of Hospital Compliance with Medicare's Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status CodesNext Generation Accountable Care Organization - ImplementationInpatient Rehabilitation Facility (IRF) Medical Review ChangesHow to Use the Medicare Coverage DatabaseJM Part A 2020 Opioid Treatment Program (OTP) RatesNew Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES ActCredit Balance Reports: Submission Tips Meeting CMS StandardsMedicare Advantage Plan Directory (CMS website)Reminder on Billing Requirements Implemented for non-OPPS ProvidersPlease Do Not Email Protected Health Information (PHI)Institutional Billing ResourcesSubmit Medical Record Documentation via esMDDate of Service ReportingMedicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementEmergency Medical Treatment and Labor Act (EMTALA) and the Born-Alive Infant Protection ActTotal Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight RuleBilling for Services when Medicare is a Secondary PayerBilling Instructions for Investigational Device Exemptions (IDEs)Provider Compliance Tips for Polysomnography (Sleep Studies) - RevisedMedicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingRequest for Accelerated Payment InstructionImportant Credit Balance (CMS-838) Report InformationVitamin B-12 Medicare Coverage GuidelinesReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesTop Time-Saving Tools for Palmetto GBA ProvidersCOVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized IndividualsAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsA Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019Writing Therapy GoalsLocal Coverage Determinations (LCDs)Identify a Medicare Advantage PlanClaims reporting HCPCS Code C9399 - Unclassified Drugs or BiologicalsFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsNCD 20.4 Implantable Cardiac Defibrillators (ICDs)JM Part A 2021 Opioid Treatment Program (OTP) RatesAccepting Payment from Patients with a Medicare Set-Aside ArrangementMedicare Plans to Modernize Payment Grouping and Code Editor SoftwareMedicare Advantage (MA) Plans Adherence to Local and National Coverage Determination InquiriesAlpha-Numeric HCPCSIdentify a ProviderServices Excluded By StatuteEntering Beneficiary Information: eServices Eligibility Inquiry vs. Claim SubmissionUnsolicited Fax or Email InquiryNew Requirements Added for Changing and Resetting Passwords in Direct Data Entry (DDE)Remicade ChecklistAlcohol Misuse Screening and CounselingRituxan ChecklistZ Codes That May be Principal/First-Listed DiagnosisImportant Tax Information - 1099 FormsPolysomnography (Sleep Study)Livanta's Memorandum of Agreement (MOA) for Healthcare ProvidersManual TherapyProstate Cancer ScreeningsBankruptcyPayment Rate for 340B-acquired Drug ReimbursementDRG 329 - 331 Major Small and Large Bowel ProceduresOutpatient Therapy Cap Repeal and KX Modifier UseProlia ChecklistLooking for Medicare Coverage Information?Occurrence Code 50: RemindersNeulasta ChecklistAvastin ChecklistTherapeutic ExerciseStandard Operating Procedures for Diagnostic TestingHow To Recognize an SMRC AuditReminder of Advance Beneficiary Notice of Noncoverage (ABN) RenewalBilling Drug Waste with C9399Jurisdictions J and M Quarterly Medicare Part A Updates, Changes and RemindersSingle Use Vial/Package Drug Wastage Billing and Coverage GuidelinesProliaRemittance Advice Resources and FAQs (CMS Product)Recovery Audit Contractor (RAC) InformationDurable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Part APromoting Interoperability (PI) ProgramsModerate Sedation ServicesQuarterly 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 PaymentMedicare Diabetes Prevention Program Suppliers: Separate Medicare EnrollmentHospitals: Physician Time Studies During the COVID-19 PHEInpatient Rehabilitation Facility (IRF) ResourcesClarification of Negative ReimbursementLong Term Care Hospital (LTCH) Prospective Payment System (PPS) Interrupted Stay PolicySave Time with eTicketCertifying Patients for the Medicare Home Health BenefitCMS Open Payments Data WebsiteNew Medicare Beneficiary Identifier (MBI) Get It, Use ItFace-to-Face Encounters and Certification for Home Health Care and Physician Documentation RequirementsWhy isn't Mary Receiving the Home Health Care Her Physician Ordered?Provider Self Service ApplicationsRepayment 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, 2021International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) - October 2021National Coverage Determination (NCD) 210.3 - Screening for Colorectal Cancer (CRC) - Blood-Based Biomarker TestsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021 July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)July 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)July 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.2Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 Update'What If' and Scenario QuestionsMLN Connects Special Edition - Thursday, July 1, 2021October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementJuly Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSection 50 in Chapter 30 of Publication (Pub.) 100-04 Manual UpdatesImplement 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) COREOctober 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesMLN Connects Special Edition: Monday, August 2, 2021National Coverage Determination (NCD) RemovalInternet 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 2022Changes to the Laboratory National Coverage Determination [NCD] Edit Software for October 2021Biden-Harris Administration Takes Additional Action to Protect America's Nursing Home Residents from COVID-19Implement 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 240.6Implementation 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)Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022Provider ResponsibilityMedically Unlikely Edits (MUE) ProgramDiscontinuation of Common Working File (CWF) Eligibility Access for New Direct Data Entry (DDE) ID RequestsSkin Substitute CodesProvider Alert: Discontinuation of Common Working File Eligibility TransactionsCalendar 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 RequirementsWays to Connect to Palmetto GBANew 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 UpdateAn 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 CoverageMLN Connects for Thursday, February 24, 2022The 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)MLN Connects for Thursday, March 3, 2022Internet-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)Federally Qualified Health Centers: Retroactive Claims AdjustmentsMLN Connects for Thursday, March 10, 2022April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleMLN Connects for Thursday, March 17, 2022Need a Quick Answer to Your Part A Medicare QuestionMLN Connects for Thursday, March 24, 2022April 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 90677MLN Connects Special Edition: Wednesday, March 30, 2022Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health CentersMLN Connects for Thursday, March 31, 2022MLN Connects Special Edition: Thursday, March 31, 2022MLN Connects Special Edition: Monday April 4, 2022MLN Connects Special Edition: Wednesday, April 6, 2022MLN Connects for Thursday April 7, 2022MLN Connects Special Edition: Thursday, April 8, 2022Unsolicited Voluntary RefundsMLN Connects Special Edition: Monday, April 11, 2022MLN Connects for Thursday, April 14, 2021MLN Connects Special Edition for Monday, April 18, 2022Update 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 UpdatesMLN Connects for Thursday, April 21, 2022MLN Connects for Thursday, April 28, 2022CWF 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)Update to the Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2022Changes 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 to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs)-October 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, May 12, 2022If You've Contacted Us Recently, We Would Love to Hear About Your Experience!MLN Connects for Thursday, May 19, 2022eTicket Enables Providers to Save Time with Every CallePass is Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA's Provider Contact Center

Last Updated: 04/01/2016