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Medicare Transmittals & MLN Articles

August 7, 2026: MLN MM14544: Inpatient Rehabilitation Facility Prospective Payment System: FY 2027 Web Pricer Update

Make sure your billing staff knows about FY 2027 IRF Prospective Payment System updates (rural transition policy and wage index cap), effective October 1, 2026. https://www.cms.gov/files/document/mm14544-inpatient-rehabilitation-facility-prospective-payment-system-fy-2027-web-pricer-update.pdf 

August 10, 2026: MLN MM14519: Medicare Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2027 Update

CMS reduces IPPS payment for certain MS-DRGs when a hospital replaced an implanted device at no cost or with a credit equal to 50% or more of its replacement cost. CMS adds new MS-DRGs to the list when they include procedures assigned to an MS-DRG previously on the list. Effective October 1, 2027 8 MS-DRGs are being deleted from the list (MS-DRG 258, 259, 260, 261, 262, 466, 467, and 468) and 3 new MS-DRGs are being added to the list: 

• 210: Cardiac Pacemaker Revision or Device Replacement with MCC
• 211: Cardiac Pacemaker Revision or Device Replacement without MCC
• 449: Revision of Hip or Knee Replacement. 

https://www.cms.gov/files/document/mm14519-medicare-severity-diagnosis-related-groups-subject-inpatient-prospective-payment-system.pdf 

August 14, 2026: MLN MM14537: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (1 of 2)

NCDs with coding changes to be implemented January 4, 2027 include: 

NCD 90.2 – Next Generation Sequencing (NGS), 

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis, 

NCD 150.3 – Bone (Mineral) Density Studies, 

NCD 220.4 – Mammograms,

NCD 250.4 – Treatment of Actinic Keratosis, and

NCD 270.3 – Blood-Derived Products for Chronic Non-Healing Wounds. 

https://www.cms.gov/files/document/mm14537-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-1-2.pdf 

August 18, 2026: MLN MM14570: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (2 of 2)

NCDs with coding changes to be implemented January 4, 2027 include:

NCD 20.30 – Microvolt T-Wave Alternans (MTWA), 

NCD 20.4 – Implantable Cardioverter Defibrillators (ICDs),

NCD 190.3 – Cytogenetic Studies,

NCD 220.6.17 – Positron Emission Tomography (FDG) for Oncologic Conditions, 

NCD 260.1 – Adult Liver Transplantation, and

NCD 260.5 – Intestinal and Multi-Visceral Transplantation.

https://www.cms.gov/files/document/mm14570-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-2-2.pdf 

August 25, 2026: MLN MM14569: Clinical Laboratory Fee Schedule & Clinical Laboratory Improvement Amendments HCPCS Codes, Waived Tests & Reasonable Charge Payments: October 2026 Quarterly Update

Make sure your bill staff knows about Clinical Laboratory Fee Schedule (CLFS) updates, effective October 1, 2026 including annual and quarterly CLIA edits, new waived test updates, and new and deleted CPT codes. https://www.cms.gov/files/document/mm14569-clinical-laboratory-fee-schedule-clinical-laboratory-improvement-amendments-hcpcs-codes.pdf 

September 2, 2026: MLN MM14581: National Coverage Determination 210.3: Colorectal Cancer Screening Tests – Non-Invasive Biomarker Testing

Effective June 8, 2026, CMS determined non-invasive biomarker screening tests are appropriate for colorectal cancer (CRC) screening based on specific criteria (Aged 45-85, asymptomatic, at average risk). https://www.cms.gov/files/document/mm-14581-national-coverage-determination-210-3-colorectal-cancer-screening-tests-non-invasive.pdf 

September 4, 2026: MLN MM14553: Medicare Secondary Payer Claim Processing for Certain Claim Adjustment Reason Codes

Key update for your billing staff is MACs will return certain claims to you if they determine that Medicare can’t process them. They will continue to identify the reason for the return on the remittance advice. Providers will have the chance to correct returned claims and, in many cases, resubmit them to the primary payer or Medicare for re-processing. https://www.cms.gov/files/document/mm14553-medicare-secondary-payer-claim-processing-certain-claim-adjustment-reason-codes.pdf 

September 14, 2026: MLN MM14592: Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2027 Changes

Make sure your billing staff is aware of the FY 2027 updates, for example, CMS deleted 18 MS-DRGs and finalized 14 new MS-DRGs, decreasing the number of MS-DRGs by 4 to 768. Several of the new MS-DRGs have been added to the list of MS-DRGs subject to the post-acute care transfer policy. https://www.cms.gov/files/document/mm14592-inpatient-long-term-care-hospital-prospective-payment-systems-fy-2027-changes.pdf 

October 1, 2026: MLN MM14589: Hospital Outpatient Prospective Payment System: October 2026 Update

Make sure your billing staff knows about CPT proprietary laboratory analysis (PLA) coding changes, new Category III CPT and HCPCS codes, ambulatory payment classification (APC) assignment, descriptor, and status indicator changes, drugs, biologicals and radiopharmaceuticals updates, skin substitute products updates, and qualifying non-opioid treatments for pain relief. https://www.cms.gov/files/document/mm14589-hospital-outpatient-prospective-payment-system-october-2026-update.pdf 

Coverage Updates

August 7, 2026: RAPID Coverage Pathway (CMS-3487-NC)

CMS issued a proposed procedural notice outlining a faster way for manufacturers to get new devices covered by Medicare: the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway. According to a CMS Fact Sheet, “this new Medicare coverage pathway will accelerate beneficiary access to eligible Class II FDA-designated Breakthrough Devices participating in FDA’s Total Product Life Cycle Advisory Program (TAP) and to eligible Class III FDA-designated Breakthrough Devices (regardless of TAP participation.)  

CMS is accepting comments by October 13, 2026.

Related CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/regulatory-alignment-predictable-immediate-device-coverage-pathway-cms-3487-nc-procedural-notice 

RAPID Coverage Pathway Infographic: https://www.cms.gov/files/document/rapid-coverage-pathway-infographic.pdf 

September 10, 2026: TAVR Final Decision Memo for Aortic Stenosis and New Tracking Sheet for Aortic Regurgitation

CMS published the Transcatheter Aortic Valve Replacement (TAVR) Final Decision Memo (CAG-00430R2). The NCD has been updated to cover TAVR for symptomatic severe aortic valve stenosis (or aortic stenosis (AS)) without coverage with evidence development (CED) requirement, expand coverage of TAVR to asymptomatic severe AS with CED, and revise coverage criteria related to pre-procedural patient assessment, intraoperative requirements, and operator and hospital procedural volume requirements. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=321

Also on September 10, 2026, CMS initiated a new national coverage analysis (NCA) for TAVR for aortic regurgitation. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324

The NCA public comment period ends October 10,2026 and the proposed Decision Memo due date is March 10, 2027. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324 

September 23, 2026: National Coverage Analysis: Screening for Hepatitis C Virus (HCV) in Adults

Currently, NCD 210.13 covers screening for beneficiaries who meet one of two conditions: adults at “high risk” for HCV infection or adults born between 1945 and 1965. CMS has received five formal requests to reconsider the NCD. CMS indicates the NCD analysis will align with the scope of the requests and focus on screening HCV in adults aged 18 to 79, as recommended by the US Preventive Services Task Force (USPSTF). The public comment period ends October 23, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=325 

September 2026: CMS National Coverage Determination Dashboard Updated

CMS notes in this updated dashboard that “At-A-Glance” there are three open NCDs, five NCDs have been finalized in the last twelve months, there are no pending Transitional Coverage for Emerging Technologies (TCETs) and eleven NCDs on their wait list. https://www.cms.gov/files/document/ncddashboard.pdf 

Other Updates

August 24, 2026: $144 Million to Improve Mental Health, Substance Abuse, Emergency and Maternal Care and Expand the Healthcare Workforce in Alabama

This investment is being delivered through the Rural Health Transformation Program (RHTP). According to the CMS Press Release, “this investment will support 138 grants to expand access to care, modernize healthcare technology and infrastructure and strengthen the rural healthcare workforce.” You can read more about this funding in the CMD Press Release at https://www.cms.gov/newsroom/press-releases/trump-administration-announces-144-million-improve-mental-health-substance-abuse-emergency-maternal.

September 16, 2026: Adjustment to the Amount in Controversy Threshold Amounts for CY 2027

CMS published a notice in the Federal Register announcing the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. Effective for requests for ALJ hearings and judicial review filed on or after January 1, 2027, the AIC threshold amounts are $200 (up from $190 in 2026) and for ALJ hearings $2,000 (up from $1,960 in 2026) for judicial review. https://www.govinfo.gov/content/pkg/FR-2026-09-16/pdf/2026-19016.pdf 

September 30, 2026: CMS Releases Q2 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPR) for Short Term Acute-Care hospitals. 

CMS released the Q2 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals on September 30th. In the Thursday, October 1, 2026 edition of MLN Connects, CMS notes providers can use this report to spot billing patterns that many need review or improvement, identify areas that may need closer monitoring or internal audits, find services that may be under-coded or over-coded, and track trends like longer patient stays. You can find how to get your PEPPER and more information about the report in MLN Connects newsletter at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-october-1-2026.

Medicare Transmittals & MLN Articles

June 25, 2026: MLN MM14522: Ambulatory Surgical Center Payment System: July 2026 Update

Make sure your billing staff knows about the ASC payment system updates effective July 1, 2026, for example CMS has approved one new device pass-through status under the Hospital OPPS, and they are establishing the new device category in the ASC payment system. The new HCPCS code C1609 (vertebral device, motion preserving with screw fixation is effective July 1, 2026. https://www.cms.gov/files/document/mm14522-ambulatory-surgical-center-payment-system-july-2026-update.pdf

July 7, 2026: MLN MM14513: DMEPOS Fee Schedule: July 2026 Quarterly Update

Make sure your billing staff knows about guidance on continuing the KF modifier on claims for non-invasive osteogenesis stimulators (HCPCS codes E0747, E0748, and E0760) for dates of service on or after May 18, 2026. https://www.cms.gov/files/document/mm14513-dmepos-fee-schedule-july-2026-quarterly-update.pdf

July 9, 2026: HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update

Make sure your billing staff knows about the 19 new HCPCS codes CMS is adding to the home health (HH) consolidated billing (CB) non-routine supply code list, effective October 1, 2026. https://www.cms.gov/files/document/mm14510-hcpcs-codes-used-home-health-consolidated-billing-enforcement-october-2026-quarterly-update.pdf

July 10, 2026: MLN MM14495: Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology

Make sure your billing staff knows to use a modifier or G code on hospice claims when reporting face-to-face encounters for recertification using telecommunications technology, starting January 1, 2027. https://www.cms.gov/files/document/mm-14495-hospice-claims-reporting-face-face-encounter-recertification-using-telecommunications.pdf

Coverage Updates

July 7, 2026: MLN MM14536: Laboratory National Coverage Determination Edit Software: October 2026 Update

Make sure your billing staff knows about eleven National Coverage Determinations (NCDs) with added and deleted ICD-10-CM Codes for the October 2026 updates. https://www.cms.gov/files/document/mm14536-laboratory-national-coverage-determination-edit-software-october-2026-update.pdf

July 30, 2026: National Coverage Analysis: Autologous Stem Cell Transplantation (AuSCT) for Multiple Myeloma)

The American Society of Hematology, Association of Cancer Care Centers, Corewell Health, International Myeloma Foundation, and Medical University of South Carolina, Hollings Cancer Center submitted a request CMS amend NCD 110.23 regarding coverage of autologous stem cell transplantation (AuSCT) to include a disease staging system for multiple myeloma supported by current clinical guidelines. CMS has published a Proposed Decision Memo and are accepting comments until August 29, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=323

Compliance Education Updates

July 2026: MLN Fact Sheet: MLN908764: Medicare Part D Vaccines

CMS reviewed this Fact Sheet in July. Even though there were no substantive changes, this is a good resource to understand what vaccines Medicare Parts B and D covers. https://www.cms.gov/files/document/mln908764-medicare-part-d-vaccines.pdf

July 2026: MLN Fact Sheet: MLN7172818: Guiding an Improved Dementia Experience (GUIDE) Model

This 8-year voluntary national model started July 1, 2024 and offers a standardized approach to comprehensive dementia care, 24/7 access to an interdisciplinary care team member or help line, and caregiver education and support services, including respite services. Several substantive updates were made to this Fact Sheet in July. For example, the Model goals were updated to include the goal of improving coordination between care teams and community-based organizations. https://www.cms.gov/files/document/mln7172818-guiding-improved-dementia-experience-model.pdf

Other Updates

July 14, 2026: CY 2027 Medicare Physician Fee Schedule Proposed Rule

CMS is soliciting public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare part B issues (i.e., Medicare Shared Savings Program Requirements and Remote Monitoring).

You can read more about this proposed rule, including links to more information, in the Thursday, July 16, 2026 edition of CMS’ MLN Connects Newsletter at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-july-16-2026

CMS is accepting comments through August 31, 2026.

July 13, 2026: Medicare Beneficiary Date of Death: Manual Update

In the July 23, 2026 edition of MLN Connects, CMS alerts providers that a new section (210) has been added to the Medicare Claims Processing Manual, Chapter 1- General Billing Requirements. This section provides guidance on how to correct an incorrect date of death in Medicare records. CMS notes “Medicare records may incorrectly indicate that a patient has died or may list an incorrect date of death. When this occurs, Medicare won’t process claims for reimbursement until the error is corrected. This manual explains common causes of incorrect dates of death and the steps providers should take to resolve them.” The effective date for this new information is July 13, 2026.

Resources

Medicare Claims Processing Manual, Chapter 1: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c01.pdf

CMS MLN Fact Sheet (MLN7216774) March 2026: https://www.cms.gov/files/document/mln7216774-fix-death-date-errors-medicare-records.pdf

June 11, 2026 Transmittal 13826 (Change Request 14500): Subject: Medicare Beneficiary Date of Death – Manual Update: https://www.cms.gov/files/document/r13826cp.pdf

July 17, 2026: Required Remittance Advice Remark Codes Related to the No Surprises Act

CMS released guidance on the required remittance advice remark codes noting “these regulations are intended to improve communication between parties by ensuring that remittance advice include information relevant to adjudication of claims, including information used to determine whether a payment dispute is eligible for the Federal IDR process. These regulations are effective as of August 3, 2026.” https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/caa-nsa-rarc-codes.pdf

July 29, 2026: Fiscal Year 2027 Skilled Nursing Facility Final Rule (CMS-1843-F)

In this final rule, CMS finalized updates to the Skilled Nursing Facility (SNF) payment rates, “for an estimated increase of $882.74 million in aggregate payments to SNFs.”

July 29, 2026: Fiscal Year 2027 Inpatient Psychiatric Facility Final Rule (CMS-1847-F)

For FY 2027, CMS estimates payments to Inpatient Psychiatric Facilities (IPFs) would increase by 2.3%, or $60 million, in FY 2027, relative to IPF payments in FY 2026.

You can read more about the SNF and IPF final rules, including links to more information, in the Thursday, July 30, 2026 edition of CMS’ MLN Connects Newsletter at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-july-30-2026

July 31, 2026: Fiscal Year 2027 Inpatient Prospective Payment System and LTCH Final Rule

With the release of the Final Rule, CMS announced the expansion of the Comprehensive Care for Joint Model that ran from April 2016 through December 2024. The new Joint Replacement Expanded (CJR-X) Model will be the first expanded mandatory test of an episode-based payment model and will begin January 2028.

Medicare Transmittals & MLN Articles

May 5, 2026: MLN MM14354: Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirements

This article was first published on January 29, 2006. With this second iteration CMS has added HCPCS code G0491 to the billing requirements for acute kidney injury hemodiafiltration claims. As a reminder, starting July 1, 2026, ESRD facilities don’t need to submit the AX modifier on claims eligible for certain add-payment adjustments under ESRD PPS and facilities must adhere to new billing instructions for hemodiafiltration and AKI claims. https://www.cms.gov/files/document/mm14354-acute-kidney-injury-esrd-billing-ending-ax-modifier-requirement.pdf

May 27, 2026: MLN MM14468: Rural Health Clinics & Federally Qualified Health Centers: Billing Distant Site Telehealth Services

Make sure your billing staff knows that RHCs and FQHCs must bill the individual CPT or HCPCS code for distant site telehealth services they provide instead of HCPCS code G2025, effective October 1, 2026. https://www.cms.gov/files/document/mm14468-rural-health-clinics-federally-qualified-health-centers-billing-distant-site-telehealth.pdf

June 2, 2026: MLN MM14464: ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2026

Make sure your billing staff knows about NDCs with new or deleted ICD-10 diagnosis codes effective October 1, 2026. Relevant coding changes in the related Change Request (CR)14464 include:

NCD 20.4 – Implantable Cardioverter Defibrillations (ICDs)

NCD 90.2 – Next Generation Sequencing (NGS)

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis

NCD 110.23 – Stem Cell Transplant

NCD 110.24 – Chimeric Antigen Receptor (CAR) T-cell Therapy

NCD 150.3 – Bone (Mineral) Density Studies

NCD 220.6.1 – PET for Perfusion of the Heart

NCD 250.4 – Treatment of Actinic Keratosis

https://www.cms.gov/files/document/mm14464-icd-10-other-coding-revisions-national-coverage-determinations-october-2026-update.pdf

June 18, 2026: MLN MM14477: Hospital Outpatient Prospective Payment System: July 2026 Update

Make sure your billing staff knows about the OPPS updates effective July 1, 2026, for example CMS has approved two new drugs (TOFIDENCE® and ACTEMRA®) for intravenous administration in hospitalized adults with COVID-19 who get systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation. Effective July 1, 2026 CMS has established HCPCS code Q0234 to describe TOFIDENCE to treat COVID-19 and the associated HCPCS administrative codes M0231 and M0232. https://www.cms.gov/files/document/mm14477-hospital-outpatient-prospective-payment-system-july-2026-update.pdf

Coverage Updates

June 4, 2026: CMS GLP-1 Bridge Starting July 1, 2026

In the June 4, 2026 edition of MLN Connects, CMS released educational materials to support the Medicare GLP-1 Bridge set to start on July 1, 2026. Through this short-term demonstration, CMS is expanding access to certain GLP-1 medications to eligible Part D beneficiaries who do not currently have access to these medications through the Part D benefit. The GLP-1 Bridge demonstration will be from July 1, 2026 through December 31, 2027.

 https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-june-4-2026

Link to CMS.gov GLP-1 Bridge webpage: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge

June 8, 2026: Final Decision Memo: Screening for Colorectal Cancer-Non-Invasive Biomarker Tests

CMS final decision is that noninvasive biomarker colorectal cancer screening tests are covered once every three years when all ordering, patient and test criteria in this policy are met.

https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=319

June 15, 2026: CMS Published Proposed Decision Memo for NCD 20.32: Transcatheter Aortic Valve Replacement

The TAVR NCD 20.32 first became effective May 1, 2012 for the treatment of symptomatic aortic valve stenosis. The second iteration of this policy was effective June 21, 2019. This most recent reconsideration was initiated by Ewards Lifesciences in July 2025 indicating a “reconsideration is needed to reflect new published evidence demonstrating improved outcomes with the use of TAVR for asymptomatic patients that are beyond the scope of the current NCD, as well as additional evidence supporting the removal of coverage with evidence development (CED) and other outdated requirements in the NCD.”

CMS has proposed to:

• Cover TAVR for symptomatic severe aortic valve stenosis without the CED requirement,
• Expand coverage to asymptomatic severe AS with CED, and
• Review coverage criteria related to pre-procedural patient assessment, intraoperative requirements, and operator and hospital procedural volume requirements.

The public comment period is through July 15, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&ncaid=321&fromTracking=Y&doctype=all&timeframe=30&sortBy=updated&bc=21

June 17, 2026: June Update to CMS National Coverage Determination (NCD) Dashboard

CMS indicates “at a glance” there are two open NCDs, six NCDs have been finalized in the past 12 months, there are no pending Transitional Coverage for Emerging Technologies (TCET) topics, and eleven topics are on the NCD wait list. To learn more about the open, latest, and pending NCDs topics click here https://www.cms.gov/files/document/ncddashboard.pdf.

Compliance Education Updates

May 2026: MLN97302356: Skilled Nursing Facility 3-Day Rule Billing

CMS has updated this MLN Fact Sheet to include information on the Transforming Episode Accountability (TEAM) Skilled Nursing Facility (SNF) 3-Day Rule Waiver. https://www.cms.gov/files/document/skilled-nursing-facility-3-day-rule-billing.pdf

Other Updates

June 5, 2026: ICD-10-CM/PCS Updates

The FY 2027 ICD-10-PCS procedure code files and guidelines have been posted to the CMS.gov ICD-10 webpage. Use these codes for discharges on or after October 1, 2026 through March 31, 2027.

The FY 2027 ICD-10-CM diagnosis code files (POA Exempt Codes, Conversion Table, Code and Descriptions in Tabular Order, Addendum, and Code Tables, Tabular and Index) has also been posted to this webpage. Use these codes for discharges on or after October 1, 2026 through September 30, 2027.

https://www.cms.gov/medicare/coding-billing/icd-10-codes

June 16, 2026: Final Rule CMS-3367-FC: Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions

CMS notes in the Federal Register that “This final rule with comment period sets forth provisions to strengthen the oversight of Medicare national accrediting organizations by addressing conflicts of interest, establishing consistent standards, processes, and definitions, and updating the validation and performance standards systems. Additionally, this final rule with comment period revises the psychiatric hospital survey process, adds a limitation on terminated deemed providers and suppliers when reentering the program, and provides technical corrections for End-Stage Renal Disease facilities and Transplant Programs.”

A related CMS Memorandum to State Survey Agencies and AOs was also issued on June 16, 2026. The three points made by CMS in the memorandum summary are 1) they are providing information on the requirements for the new AO oversight rule published on June 16, 2026 (91 FR 36370), 2) these regulations are effective 1 (one) year after publication at the Federal Register, and 3) they are raising awareness to ensure providers and suppliers deemed under a CMS approved AO become familiar with the upcoming changes that could impact them.

CMS also provided the guidance that “For the provider and supplier community and those facilities deemed under a CMS-approved AO, your respective AO is expected to communicate with your organization regarding these requirements, including the requirement that AOs must adopt the same language in the Medicare conditions for their respective AO program standards.”

Resources

• Final Rule CMS-3367-FC: https://www.govinfo.gov/content/pkg/FR-2026-06-16/pdf/2026-12069.pdf
• Memorandum QSO-26-10-[ALL]: https://www.cms.gov/files/document/qso-26-10-all-original-release-2026-06-16.pdf
• CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-ensures-accrediting-organizations-uphold-trust-standards-oversight
• CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/strengthening-cms-oversight-accrediting-organizations

June 18,2026: Q1 FY 2026 PEPPER Released

CMS announced the release of the Q1 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. According to CMS, hospitals can use this report to:

• Spot billing patterns that may need improvement,
• Identify areas that may need audits or closer monitoring,
• Find diagnosis-related groups (DRGs) that may be under-coded or over-coded, and
• Track areas where patient stays are getting lower.

You can read the CMS announced in the June 18 edition of MLN Connects at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-june-18-2026

June 30, 2026: FY 2027 ICD-10-CM Official Guidelines for Coding and Reporting

CDC has released the updated guidelines effective October 1, 2026. While there are few changes to the guidelines, it is a good refresher for seasoned professionals and a learning tool for new coding and Clinical Documentation Integrity professionals. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html

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