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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Therapy Claims: Reprocessing Dates of Service from January 1 through February 15 01/15/2021
January 2021 Update of the Ambulatory Surgical Center (ASC) Payment System Open in New Window01/06/2021
Billing for Home Infusion Therapy Services On or After January 1, 2021 Open in New Window01/05/2021
2021 Annual Update to the Therapy Code List Open in New Window01/04/2021
Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 87811 and 87428 Open in New Window12/28/2020
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 27.1, Effective April 1, 2021 Open in New Window12/28/2020
Updating Calendar Year (CY) 2021 Medicare Diabetes Prevention Program (MDPP) Payment Rates Open in New Window12/28/2020
Telehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - Implementation Open in New Window12/23/2020
Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable Charge Open in New Window12/21/2020
FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients 12/21/2020
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
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
FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients Open in New Window12/04/2020
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
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
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
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) 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
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
New Waived Tests Open in New Window10/16/2020
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
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 to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 27.0, Effective January 1, 2021 Open in New Window09/28/2020
October 2020 Update of the Ambulatory Surgical Center (ASC) Payment System Open in New Window09/25/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window09/25/2020
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
National Coverage Determination (NCD 90.2): Next Generation Sequencing (NGS) for Medicare Beneficiaries with Germline (Inherited) Cancer Open in New Window09/16/2020
Internet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19 Open in New Window09/08/2020
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
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window08/28/2020
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
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
New Waived Tests Open in New Window07/29/2020
Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426 Open in New Window07/27/2020
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Open in New Window07/27/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window07/10/2020
July 2020 Update of the Ambulatory Surgical Center (ASC) Payment System Open in New Window07/07/2020
Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update Open in New Window07/07/2020
National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS) Open in New Window06/25/2020
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 26.3, Effective October 1, 2020 Open in New Window06/24/2020
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
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 Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule Open in New Window06/08/2020
Educational Resources to Assist Chiropractors with Medicare Billing Open in New Window05/29/2020
Foot Care Coverage Guidelines Open in New Window05/29/2020
Medicare Coverage for Chiropractic Services - Medical Record Documentation Requirements for Initial and Subsequent Visits Open in New Window05/29/2020
Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449) Open in New Window05/29/2020
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
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
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update Open in New Window05/06/2020
Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635 Open in New Window04/29/2020
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
New Waived Tests 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
April 2020 Update of the Ambulatory Surgical Center (ASC) Payment System Open in New Window04/15/2020
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window04/08/2020
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
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 26.2, Effective July 1, 2020 Open in New Window03/31/2020
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 26.1, Effective April 1, 2020 Open in New Window03/27/2020
Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits Open in New Window03/26/2020
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
Incorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any Type Open in New Window03/05/2020
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
New Medicare Beneficiary Identifier (MBI) Get It, Use It Open in New Window02/13/2020
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
Quarterly Influenza Virus Vaccine Code Update - July 2020 Open in New Window02/05/2020
2020 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List Open in New Window02/03/2020
2020 Annual Update to the Therapy Code List Open in New Window01/31/2020
Calendar Year (CY) 2020 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Open in New Window01/27/2020
Implementation to Exchange the List of Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System Open in New Window01/22/2020
Provider Compliance Tips for Polysomnography (Sleep Studies) - Revised 01/21/2020
Medicare Fee-for-Service (FFS) Response to the 2020 Commonwealth of Puerto Rico Earthquakes Open in New Window01/14/2020
Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System Open in New Window01/09/2020
Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical Equipment Open in New Window12/16/2019
Overview of the Patient Driven Groupings Model Open in New Window11/25/2019
Payments and Payment Adjustments under the Patient-Driven Groupings Model Open in New Window11/25/2019
Hurricane Dorian and Medicare Disaster Related States of Georgia and South Carolina Claims Open in New Window09/05/2019
Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain Management Open in New Window08/21/2019
Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention Program 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
Guidance on Coding and Billing Date of Service on Professional Claims Open in New Window02/04/2019
Certifying Patients for the Medicare Home Health Benefit 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
Reminder on Billing Requirements Implemented for non-OPPS Providers Open in New Window09/05/2018
Review of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) Open in New Window08/30/2018
Current Medicare Coverage of Diabetes Supplies Open in New Window08/17/2018
Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program Open in New Window06/27/2018
Medicare Fee-for-Service (FFS) Response to the 2017 California Wildfires Open in New Window04/03/2018
Medicare Fee-for-Service (FFS) Response to the 2017 Southern California Wildfires Open in New Window04/03/2018
Proper Coding for Specimen Validity Testing Billed in Combination with Drug Testing Open in New Window04/02/2018
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
   

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