Knowledge Base Article

Medicare Transmittals & MLN Articles

 

March 5, 2026: MLN MM14263: ICD-10 & Other Coding Revisions to National Coverage Determinations (NCDs): April 2026 Update

Originally published December 5, 2025, this second iteration now includes a link to the Medicare Claims Processing Manual update and the CR 14394 release date, transmittal number, and transmittal link. https://www.cms.gov/files/document/mm14263-icd-10-other-coding-revisions-national-coverage-determinations-april-2026-update.pdf

 

March 9, 2026: MLN MM14311: Cardiac Contractility Modulation for Heart Failure

Effective October 28, 2025, CMS covers Cardiac Contractility Modulation (CCM) for treating heart failure (HF) under coverage with evidence development (CED) according to the coverage criteria outlined in NCD 20.39. This article was first published on December 22, 2025. It was revised on March 9^th to add 4 additional place of service (POS) codes for professional claims processing (11-Office, 24-Ambulatory Surgical Center, 71–Public Health Clinic, and 72-Rural Health Clinic). https://www.cms.gov/files/document/mm14311-cardiac-contractility-modulation-heart-failure.pdf

 

March 13, 2026: MLN MM14380: Hospital Outpatient Prospective Payment System: April 2026 Update

Make sure your billing staff knows updates effective April 1, 2026 for example new COVID-19 monoclonal antibody products and administration codes and new proprietary laboratory analyses (PLA) codes and Hospital OPPS device categories. https://www.cms.gov/files/document/mm14380-hospital-outpatient-prospective-payment-system-april-2026-update.pdf

 

Coverage Updates

 

February 2026: MLN4443820: Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance

This MLN Fact Sheet has been updated to include more information on what type of insulin and insulin pumps CMS covers under Medicare Part B. https://www.cms.gov/files/document/mln4443820-billing-medicare-part-b-insulin-new-limits-patient-monthly-coinsurance.pdf

 

February 2026: MLN7674574: Medicare Coverage of Diabetes Supplies

This MLN Fact Sheet has been updated to clarify that CMS covers diabetes supplies during an inpatient stay for patients who have diabetes under a bundled payment through the Inpatient Prospective Payment System. https://www.cms.gov/files/document/mln7674574-medicare-coverage-diabetes-supplies.pdf

 

March 10, 2026: CAG-00440R: Screening for Colorectal Cancer-Non-Invasive Biomarker Tests Proposed Decision Memo

CMS has proposed changes to the NCD (210.3) colorectal cancer screening test according to the provisions in section I.B. (Test Criteria) and I.C. (Other Uses of Colorectal Cancer Screening Biomarker Test). The public comment period ends April 4, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=319

 

Compliance Education Updates

 

January 2026: MLN Education Tool (MLN6822507): Medicare Payment Systems

In the Thursday, March 12, 2026 edition of MLN Connects, CMS indicated the Medicare Payment Systems has been updated. All payment systems in this tool have been updated to include fiscal year or calendar year 2026 changes. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/medicare-payment-systems.html#Acute

 

March 2026: MLN Fact Sheet (MLN7215754): Hospital Price Transparency

This MLN Fact Sheet has been updated to reflect effective changes on January 1, 2026. For example, the machine-readable file (MRF) attestation requirements have been updated. https://www.cms.gov/files/document/mln7215754-hospital-price-transparency.pdf

 

March 2026: MLN Fact Sheet (MLN006270): CLIA Program & Medicare Laboratory Services

In the March update to this fact sheet, CMS updated the certification information to reflect the switch to electronic fee coupons and CLIA certificates and updated the email address for international laboratories. https://www.cms.gov/files/document/mln006270-clia-program-medicare-lab-services.pdf

 

Other Updates

 

March 11, 2026: DOJ Press Release: Aetna Agrees to Pay $117.7 Million to Resolve False Claims Allegations

Although Aetna admitted to no wrongdoing, they agreed to pay $117.7 million to resolve allegations that the company violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase payments from Medicare. You can read more about this settlement in the Department of Justice Press Release. https://www.justice.gov/opa/pr/aetna-agrees-pay-1177-million-resolve-false-claims-act-allegations

 

March 11, 2026: CMS Memorandum: Organ Procurement Organizations (OPOs) and Donor Hospitals’ Responsibilities

CMS sums up this memorandum with three key statements. First, this memorandum clarifies and reinforces the roles and responsibilities of OPOs and donor hospitals during the organ donation procurement process. Second, OPOs and hospitals are required to approach potential donors and their families in a sensitive manner, which should be free of coercion or pressure. Failure to follow the requirements constitutes noncompliance. Third, noncompliance related to this issue must be cited once identified, even if the deficiency has been corrected at the time of the survey. I encourage you to read the full document, paying close attention to the surveyor tips provided throughout the document. https://www.cms.gov/files/document/qso-26-05-opo-original-release-date-2026-03-11-pdf.pdf

 

March 12, 2026: OIG Report: Medicare Advantage Compliance Audit of Specific Diagnosis Codes Submitted to CMS by BCBS of Alabama (BCBSAL)

Medicare Advantage (MA) plans receive monthly payments from CMS based in part on the health status of their enrollees. The OIG has identified nine “high-risk” diagnoses for being miscoded, which may result in overpayments from CMS. The high-risk diagnoses are acute stroke, acute myocardial infarction, embolism, lung cancer, breast cancer, colon cancer, prostate cancer, sepsis, and pressure ulcer.

 

For the 2018-2019 payment years (audit period), BCBSAL received approximately $1.7 billion to provide coverage to its enrollees. The audit included a review of provider documented diagnosis codes on behalf of MA enrollees that mapped to one of the high-risk groups during the 2017 and 2018 service years.

 

The OIG found that for 247 of 271 sampled enrollee-years, medical records did not support the diagnosis codes resulting in $769,195 in overpayments. Based on their findings, the OIG estimated that BCBSAL received at least $7 million in overpayments for 2018 and 2019 and recommended they refund this amount to the Federal Government. https://oig.hhs.gov/reports/all/2026/medicare-advantage-compliance-audit-of-specific-diagnosis-codes-that-blue-cross-and-blue-shield-of-alabama-contract-h0104-submitted-to-cms/

 

March 16, 2026: New OIG Work Plan Item: Inpatient Claims for Neurostimulator Implantation Surgeries

The OIG’s objective for adding this to their Work Plan is that “Certain medical devices such as neurostimulators may be implanted during an inpatient procedure. Medicare covers the initial implantation and replacements or revisions to the device. Hospitals must meet Federal requirements for neurostimulator implantation surgeries to be covered by Medicare. Prior OIG audit work determined that Medicare made improper payments to hospitals for outpatient claims for neurostimulator implantation surgeries. Currently, CMS requires prior authorization for outpatient neurostimulator implantation surgeries, but not for inpatient neurostimulator implantation surgeries. Prior authorization helps CMS ensure that applicable requirements are met before the services are provided. CMS’s lack of prior authorization for inpatient neurostimulator implantation surgeries may leave this area vulnerable to potential improper payments. We will determine whether CMS made Medicare payments to hospitals for inpatient neurostimulator implantation surgeries in accordance with Federal requirements. The estimated project completion date is CMS fiscal year (FY) 2028. https://oig.hhs.gov/reports/work-plan/browse-work-plan-projects/inpatient-claims-for-neurostimulator-implantation-surgeries/

 

March 2026: Q4 FY 2025 PEPPER Release

Providers are advised in the latest Short-Term Acute Care Program for Evaluating Payment Patterns Electronic Report (PEPPER), that “the Q4 FY 2025 ST PEPPER reflects an update to the Single CC or MCC and Severe Malnutrition target area calculations. As a result, users will see a decrease in the number of claims included in the numerator for these target areas compared with PEPPERs issued prior to FY 2025. The underlying target area definitions remain unchanged.”  https://pepper.cbrpepper.org/resources/home/ST-PEPPER-UG-Q4-FY-2025-Final.pdf

 

CMS indicated in the Thursday, March 19, 2026 edition of MLN Connects that hospitals can use this report to spot billing patterns that may need improvement, identify areas that may need audits or closer monitoring, find MS-DRGs that may be under- or over-coded, and track areas where patient stays are getting longer. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-march-19-2026

 

March 13, 2026: Advanced Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131)

The updated ABN is effective now and will expire March 31, 2029. CMS has advised that providers may continue to use the expired version of the ABN until May 12, 2026, but must transition to the approved form no later than that date.

 

March 17, 2026: Important Message from Medicare (IM) (Form CMS-10065) and Detailed Notice of Discharge (DND) (Form CMS-10066)

The updated IM and DND are also effective now and will expire March 31, 2029. Providers may continue to use the expired IM and DND forms until May 15, 2026, but must transition to the approved forms no later than that date.

 

You can find more information about the CMS Beneficiary Notices Initiative (BNI) on the CMS.gov website at https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative.

 

March 20, 2026: CMS Rules Phases Out Fax Machine and Snail Mail

CMS announced in a March 20^th Press Release that fax machines and snail mail are being phased out to save taxpayers $781.98 million a year. This action is part of the Administration Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signature (CMS-0053-F) final rule. This rule is effective on May 26, 2026 and covered entities must comply by May 26, 2028. https://www.cms.gov/newsroom/press-releases/cms-rule-phases-out-fax-machines-snail-mail-save-taxpayers-781-98-million-year

 

March 24, 2026: Not an April Fool’s Joke: National Government Services (NGS) to Begin Operating as Wellpoint Federal on April 1, 2026

NGS, the Medicare Administrative Contractor (MAC) for Jurisdiction 6 (J6) (IL, MN, and WI), and JK (CT, ME, MA, NH, NY, RI, VT) will begin operating as Wellpoint Federal on April 1, 2026. Per a Wellpoint Federal March 24, 2026 FAQ document, “This is a name and brand transition…CMS remains the contracting authority. All statutory, regulatory, and oversight requirements remain in effect.” 

 

For affected providers, I encourage you to share this information with key stakeholders (i.e., Compliance and Billing).

https://www.ngscedi.com/web/ngscedi/w/important-changes-coming-to-national-government-services

 

March 27, 2026: CMS Memorandum (QSO-26-07-Hospitals/CAH) Interpretive Guidance for Hospital and Critical Access Hospital (CAH) Emergency Services Protocols and Training – Obstetrical Services Conditions of Participation

This document provides interpretive guidance for hospital and CAH requirements for emergency services protocols and provisions, with particular emphasis on emergency responses to obstetrical emergencies, to align with the obstetrical Conditions of Participation (CoPs) implementation as of July 1, 2025, and assists surveyors in evaluating compliance with regulatory requirements for emergency patient care. https://www.cms.gov/files/document/qso-26-07-hospitals-cahs-ob-cop-original-release-2026-03-27.pdf

 

March 30, 2026: CMS Memorandum (QSSAM-26-03-Hospital/CAH) Hospital Nutrition Service Obligations in Light of Updated Federal Nutrition Guidelines

CMS published this “Quality and Safety Special Alert Memo” to remind hospitals of their obligations related to patient food and nutrition services, the January 7, 2026 HHS and USDA release of Dietary Guidelines for Americans (DGAs), and that hospitals must comply with Conditions of Participation at 42 CFR §482.28.

 

CMS ends the memorandum summary by stating that “as consistent with 42 CFR §482.28 and CMS guidance, hospitals should review and revise food and nutrition service policies, standard menus, therapeutic diet protocols, and food procurement practices to align with the 2025-2030 DGAs.” https://www.cms.gov/files/document/qssam-26-03-hospital-cah-original-release-2026-03-30.pdf