Knowledge Base Article

Medicare Transmittals & MLN Articles

 

March 31, 2026: MLN MM11650: National Coverage Determination 20.19: Ambulatory Blood Pressure Monitoring

Now in it’s third iteration, this article was revised to add information from Change Request (CR) 14424, which updated the Medicare Claims Processing Manual for Ambulatory Blood Pressure Monitoring services. https://www.cms.gov/files/document/mm11650-national-coverage-determination-20-19-ambulatory-blood-pressure-monitoring.pdf

 

April 8, 2026: MLN MM14445: Ambulatory Surgical Center Payment System: April 2026 Update

Make sure your billing staff knows about ASC payment system updates, effective April 1, 2026. For example, CMS is establishing 6 new HCPCS codes, retroactive to January 1, 2026, to describe insertion, revision, or replacement and removal of hypoglossal nerve stimulators. https://www.cms.gov/files/document/mm14445-ambulatory-surgical-center-payment-system-april-2026-update.pdf

 

Related CMS Transmittal 13704 provides changes to and billing instructions for various payment policies implemented in April 2026 ASC payment system update and includes tables referenced in MLN MM14445. https://www.cms.gov/files/document/r13704cp.pdf

 

April 13, 2026: MLN MM14417: Critical Access Hospitals: Certified Registered Nurse Anesthetist Bypass for Reason Codes 31006 and 31007

Make sure your billing staff knows about system edits to prevent CAH certified registered nurse anesthetist (CRNA) outpatient service claims from getting reason codes 31006 and 31007 if they have a valid pass-through on file. https://www.cms.gov/files/document/mm14417-critical-access-hospitals-certified-registered-nurse-anesthetist-bypass-reason-codes-31006.pdf

 

April 13, 2026: MLN MM14416: Prospective Payment System Hospital Interim Billing: New Monthly Adjustment Process

Make sure your billing staff knows about updates, effective for hospital discharges on or after October 1, 2024 with an implementation date of October 5, 2026. Updates include a new monthly adjustment process for Prospective Payment System (PPS) hospital inpatient claims and enforcing correct interim billing procedures by verifying patient status and correctly applying benefit days.  https://www.cms.gov/files/document/mm14416-prospective-payment-system-hospital-interim-billing-new-monthly-adjustment-process.pdf

 

April 13, 2026: MLN MM14311: Cardiac Contractility Modulation for Heart Failure

Now in its third iteration, CMS revised this article to add information for HCPCS codes C1824, C1898, and K1030. They also updated the CR release date, transmittal numbers, and transmittal links. https://www.cms.gov/files/document/mm14311-cardiac-contractility-modulation-heart-failure.pdf

 

April 17, 2026: MLN MM14130: Billing the Laboratory Specimen Collection Travel Allowance to the 10^th of a Mile

This article was first published on July 31, 2025. With this third iteration no substantive changes were made. That said, make sure your billing staff knows about the April 1, 2026 changes including allowing you to bill HCPCS code P9603 calculated to the 10^th of a mile, how to properly bill to the 10^th of a mile, and when to bill using a whole number of miles. https://www.cms.gov/files/document/mm14130-billing-laboratory-specimen-collection-travel-allowance-10th-mile.pdf

 

Coverage Updates

 

April 23, 2026: NCD 110.17 Anti-Cancer Chemotherapy for Colorectal Cancer Removed

CMS published Change Request (CR) 14433 to inform contractors that, effective February 25, 2026, CMS reconsidered NCD 110.17 and made a final determination to remove the NCD in its entirety. CMS noted that ending coverage of off-label use of clinical items and services, including the use of the studied drugs oxaliplatin, irinotecan, cetuximab, or bevacizumab, in specific trials does not end the opportunity for coverage of these agents. Other coverage mechanisms exist including Clinical Trial Policy (NCD 310.1) and, separately off-label use of anti-cancer chemotherapeutic agents. https://www.cms.gov/files/document/r13748ncd.pdf

 

Compliance Education Updates

 

March 2026: MLN Fact Sheet (MLN006818): Clinical Laboratory Fee Schedule

In the March update to this fact sheet, CMS added the next reporting period that starts May 1, 2026, that there is no phase-in payment reduction in CY 2026, and the payment reduction cap for CYs 2027-2029 is 15%. https://www.cms.gov/files/document/mln006818-clinical-laboratory-fee-schedule.pdf

 

April 2026: MLN Booklet (MLN7358441): Clinical Laboratory Fee Schedule: Reporting Private Payor Data

This updated booklet covers how Medicare uses private payor data to set laboratory test payment rates and details reporting requirements for labs under the Clinical Lab Fee Schedule. https://www.cms.gov/files/document/mln7358441-clinical-laboratory-fee-schedule-reporting-private-payor-data.pdf

 

April 2026: MLN Educational Tool (MLN006559): Medicare Preventive Services Revised

April 2026 updates to this resource are for changes that became effective January 1, 2026.

 

Specific to the annual wellness visit, the description for HCPCS code G0136 has changed from “administration of a standardized, evidence-based Social Determinants of Health (SDoH) risk assessment” to “administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, no more often than every 6 months.” 

 

Updates to the Medicare Diabetes Prevention Program included adding HCPCS code G9871 to the list of codes that can be billed with modifier 76. This is new code effective January 1, 2026 representing 60 minutes of online (asynchronous) behavioral counseling for diabetes. CMS also removed the service frequency limit for patients.

 

The final update to this tool was adding CPT code 87494, effective January 1, 2026 related to sexually transmitted infection (STI) screening and high intensity behavioral counseling to prevent STIs.

 

Other Updates

 

March 2026: MLN Fact Sheet (MLN7216774): Fix Death Date Errors in Medicare Records

CMS opens this fact sheet by noting that sometimes Medicare records incorrectly show that a patient has died, or the records list the wrong date of death. When this happens, Medicare will not pay the claim until they get a correction. This fact sheet includes reasons these errors occur and how to fix incorrect dates of death. https://www.cms.gov/files/document/mln7216774-fix-death-date-errors-medicare-records.pdf

 

March 24, 2026: Hospital Price Transparency FAQs Updated

CMS’s hospital price transparency document is intended to be a resource for frequently asked questions (FAQs). This document was refreshed March 24, 2026 to include new 2026 updates around what was finalized in the CY 2026 OPPS/ASC final rule. One new FAQ answers the question of when the new requirements finalized are effective. CMS’ response was they “will delay enforcement of these finalized revisions until April 1, 2026…we believe this 3-month enforcement delay will provide hospitals with sufficient time to update their systems, and review, validate, and post their machine-readable files.”

 

You can find the updated FAQs and additional information on the CMS Hospital Price Transparency webpage at https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency.

 

April 10, 2026: FY 2027 IPPS Proposed Rule

The FY 2027 IPPS Proposed Rule was published in the Federal Register on April 14, 2026. CMS has proposed adding 3 diagnosis codes to the MCC list, 56 diagnosis codes to the CC list, and removing 22 diagnosis codes from the CC list including 10 Z-codes relating to homelessness and inadequate housing. Comments to CMS are due June 9, 2026. You can access the proposed rule on the CMS FY 2027 IPPS Proposed Rule Home Page at https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2027-ipps-proposed-rule-home-page.

 

April 23, 2026: CMS and FDA Announce RAPID Coverage Pathway

The Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway is a new pathway designed to expedite access to certain FDA-designated Class II and Class III Breakthrough Devices for people with Medicare.

 

According to a related FDA bulletin and CMS Press Release, “CMS will issue a proposed NCD the same day an eligible device participating in this pathway receives FDA market authorization, triggering the statutorily required 30-day public comment period. This streamlined approach could enable predicable Medicare national coverage and payment as soon as two months after market authorization, compared to approximately a year or more under the current pathway, helping Medicare beneficiaries access new technologies sooner while increasing transparency, predictability, and cost savings for innovators and clinicians.”

 

A proposed procedural notice outlining the RAPID coverage pathway will soon be published in the Federal Register and the public will have 60 days to provide comments…the effective date of the new pathway is expected to occur upon publication of the final notice in the Federal Register.

 

FDA Bulletin: https://content.govdelivery.com/accounts/USFDA/bulletins/4143479

CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-fda-announce-rapid-coverage-pathway-accelerate-patient-access-life-changing-medical-devices