MLN Articles

Palmetto GBA maintains links recent released/revised CMS MLN Matters articles. All MLN Matters articles will continue to be available on the CMS MLN Matters website.

Latest Articles

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Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable Charge Open in New Window01/27/2021
Drug Claims Rejected in Error 01/27/2021
Changes to the End Stage Renal Disease (ESRD) PRICER to Accept the New Outpatient Provider Specific File Supplemental Wage Index Fields, the Network Reduction Calculation and New Value Code for Time on Machine Open in New Window01/22/2021
Implementation 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) 2021 Open in New Window01/21/2021
Therapy Claims: Reprocessing Dates of Service from January 1 through February 15 01/15/2021
January 2021 Integrated Outpatient Code Editor (I/OCE) Specifications Version 22.0 Open in New Window01/06/2021
January 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS) Open in New Window01/06/2021
2021 Annual Update to the Therapy Code List Open in New Window01/04/2021
Instructions to Medicare Administrative Contractors (MACs) on COVID-19 Emergency Declaration Blanket Waivers for Medicare-Dependent, Small Rural Hospitals and Sole Community Hospitals Open in New Window12/28/2020
Telehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - Implementation Open in New Window12/23/2020
FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients 12/21/2020
Updates to Nursing and Allied Health Education Medicare Advantage Payment Policies Open in New Window12/16/2020
International Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - April 2021 Open in New Window12/11/2020
2021 Annual Update of Per-Beneficiary Threshold Amounts Open in New Window12/08/2020
CY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule Open in New Window12/08/2020
New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE) Open in New Window12/08/2020
Summary of Policies in the Calendar Year (CY) 2021 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 List Open in New Window12/08/2020
Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2021 - Recurring File Update Open in New Window12/08/2020
Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2021 Open in New Window12/07/2020
FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients Open in New Window12/04/2020
Review of Hospital Compliance with Medicare's Transfer Policy with the Resumption of Home Health Services and the Use of Condition Codes (A-04-18-04067) Open in New Window12/03/2020
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2020 Open in New Window12/01/2020
Claim Status Category and Claim Status Codes Update Open in New Window11/24/2020
Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2021 Open in New Window11/24/2020
Implement 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 Healthcare (CAQH) CORE Open in New Window11/24/2020
Implementation 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)" Open in New Window11/24/2020
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update Open in New Window11/24/2020
Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021 Open in New Window11/24/2020
National Coverage Determination (NCD 90.3): Chimeric Antigen Receptor (CAR) T-cell Therapy Open in New Window11/18/2020
Update to Vaccine Services Editing Open in New Window11/18/2020
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window11/10/2020
Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Claims Open in New Window11/10/2020
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2020 Update Open in New Window11/02/2020
Special Provisions for Radiology Additional Documentation Requests Open in New Window11/02/2020
October Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule Open in New Window10/29/2020
Change to the Payment of Allogeneic Stem Cell Acquisition Services Open in New Window10/22/2020
Ambulance Inflation Factor (AIF) for Calendar Year (CY) 2021 and Productivity Adjustment Open in New Window10/19/2020
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window10/19/2020
January 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Open in New Window10/12/2020
October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3 Open in New Window10/06/2020
October 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) Open in New Window09/29/2020
New Physician Specialty Code for Micrographic Dermatologic Surgery (MDS) and Adult Congenital Heart Disease (ACHD) and a New Supplier Specialty Code for Home Infusion Therapy Services Open in New Window09/28/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window09/25/2020
Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes Open in New Window09/23/2020
Update to the Medicare Claims Processing Manual Open in New Window09/21/2020
2021 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update Open in New Window09/17/2020
Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries Open in New Window09/17/2020
National Coverage Determination (NCD 90.2): Next Generation Sequencing (NGS) for Medicare Beneficiaries with Germline (Inherited) Cancer Open in New Window09/16/2020
New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act Open in New Window09/15/2020
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2021 Open in New Window09/04/2020
National Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP) Open in New Window09/02/2020
2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments Open in New Window09/01/2020
Annual Clotting Factor Furnishing Fee Update 2021 Open in New Window09/01/2020
Claim Status Category and Claim Status Codes Updates Open in New Window09/01/2020
Implement 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 Healthcare (CAQH) CORE Open in New Window09/01/2020
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2021 Open in New Window08/25/2020
Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19) Open in New Window08/25/2020
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2021 Open in New Window08/21/2020
October 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Open in New Window08/19/2020
Correction to Editing Update for Vaccine Services Open in New Window08/10/2020
Influenza Vaccine Payment Allowances - Annual Update for 2020-2021 Season Open in New Window08/05/2020
International Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs)-January 2021 Update Open in New Window08/05/2020
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window07/31/2020
Modify Edits in the Fee for Service (FFS) System when a Beneficiary has a Medicare Advantage (MA) Plan Open in New Window07/23/2020
July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) Open in New Window07/20/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window07/10/2020
Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update Open in New Window07/07/2020
New Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site Open in New Window07/06/2020
Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS) Open in New Window07/01/2020
National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS) Open in New Window06/25/2020
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2020 Update Open in New Window06/23/2020
Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer Open in New Window06/23/2020
NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR) Open in New Window06/15/2020
Value-Based Insurance Design (VBID) Model - Implementation of the Hospice Benefit Component Open in New Window06/11/2020
July 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.2 Open in New Window06/08/2020
July Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Open in New Window06/08/2020
Implement 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 Healthcare (CAQH) CORE Open in New Window05/28/2020
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update Open in New Window05/27/2020
Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules Open in New Window05/27/2020
Therapy Codes Update Open in New Window05/27/2020
COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals Open in New Window05/22/2020
Medicare Continues to Modernize Payment Software Open in New Window05/20/2020
Manual Update to Pub. 100-04, Chapter 38, to Remove Identification of Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico Section Open in New Window05/18/2020
National Coverage Determination (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM) Open in New Window05/13/2020
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 Update Open in New Window05/13/2020
Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing Open in New Window05/12/2020
Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) to Correct the Adjustment Process Open in New Window05/11/2020
Medicare Clarifies Recognition of Interstate License Compacts Open in New Window05/06/2020
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update Open in New Window05/06/2020
Updates to Ensure the Original 1-Day and 3-Day Payment Window Edits are Consistent with Current Policy Open in New Window05/04/2020
Implement 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 Healthcare (CAQH) CORE Open in New Window04/27/2020
July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer Open in New Window04/27/2020
April 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.1 Open in New Window04/20/2020
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update Open in New Window04/20/2020
Claim Status Category and Claim Status Codes Update Open in New Window04/16/2020
Quarterly Update to the Fiscal Year 2020 Inpatient Psychiatric Facilities Pricer Open in New Window04/13/2020
April 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) Open in New Window04/08/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window04/08/2020
Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) Open in New Window04/03/2020
July 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Open in New Window03/31/2020
Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations Open in New Window03/25/2020
April 2020 Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files Open in New Window03/24/2020
April Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Open in New Window03/24/2020
Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS Open in New Window03/20/2020
New Medicare Beneficiary Identifier (MBI) Get It, Use It Open in New Window03/20/2020
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window03/17/2020
The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2018 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) Open in New Window03/16/2020
NCD 20.4 Implantable Cardiac Defibrillators (ICDs) Open in New Window03/04/2020
Proper Use of Modifier 59 Open in New Window03/04/2020
Section 1876 and 1833 Cost Plan Enrollee Access to Care through Original Medicare Open in New Window03/04/2020
Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (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 Requirements Open in New Window02/28/2020
New Medicare Beneficiary Identifier (MBI) Get It, Use It Open in New Window02/25/2020
Accepting Payment from Patients with a Medicare Set-Aside Arrangement Open in New Window02/21/2020
Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional Claims Open in New Window02/21/2020
Implementation of the Long Term Care Hospital (LTCH) Discharge Payment Percentage (DPP) Payment Adjustment Open in New Window02/19/2020
January 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.0 Open in New Window02/19/2020
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - April 2020 Update Open in New Window02/12/2020
January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) Open in New Window02/05/2020
Provider Enrollment Appeals Procedure Open in New Window02/05/2020
Quarterly Influenza Virus Vaccine Code Update - July 2020 Open in New Window02/05/2020
Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked Questions Open in New Window01/22/2020
Provider Compliance Tips for Polysomnography (Sleep Studies) - Revised 01/21/2020
Update Inpatient Prospective Payment System (IPPS) Pricer and Related Claims Reprocessing Open in New Window12/16/2019
Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain Management Open in New Window08/21/2019
Emergency Medical Treatment and Labor Act (EMTALA) and the Born-Alive Infant Protection Act Open in New Window07/11/2019
Medicare Plans to Modernize Payment Grouping and Code Editor Software Open in New Window07/11/2019
Reduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing Benzodiazepines Open in New Window07/11/2019
Chimeric Antigen Receptor (CAR) T-Cell Therapy Revenue Code and HCPCS Setup Revisions Open in New Window05/30/2019
Local Coverage Determinations (LCDs) Open in New Window02/19/2019
Total Knee Arthroplasty (TKA) Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight Rule Open in New Window01/25/2019
New Electronic System for Provider Reimbursement Review Board Appeals Open in New Window01/22/2019
New Medicare Webpage on Patient Driven Payment Model Open in New Window01/15/2019
Inpatient Rehabilitation Facility (IRF) Medical Review Changes Open in New Window12/21/2018
Certifying Patients for the Medicare Home Health Benefit Open in New Window11/07/2018
Medicare Cost Report E-Filing (MCReF) Open in New Window11/07/2018
A Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 Open in New Window11/02/2018
Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations Open in New Window10/15/2018
Intensity-Modulated Radiation Therapy (IMRT) Planning Services Editing Open in New Window09/12/2018
Reminder on Billing Requirements Implemented for non-OPPS Providers Open in New Window09/05/2018
Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program Open in New Window06/27/2018
Notifying Medicare Patients about Lifetime Reserve Days (LRDs) Open in New Window05/10/2018
Skilled Nursing Facility Value-Based Purchasing Program Updated Open in New Window03/30/2018
Billing Requirements for OPPS Providers with Multiple Service Locations Open in New Window03/19/2018
Next Generation Accountable Care Organization - Implementation Open in New Window01/25/2018
Medically Unlikely Edits (MUE) and Bilateral Surgical Procedures Open in New Window01/18/2018
Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other Facilities Open in New Window12/14/2017
   

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