Knowledge Base - Recent Articles
3/31/2026
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 9th 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 20th 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
Beth Cobb
3/5/2026
Medicare Transmittals & MLN Articles
January 29, 2026: MLN MM14354: Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement
Make sure your billing staff knows about July 1, 2026 updates to billing instructions for ESRD Prospective Payment System (PPS) claims and to the Medicare Claims Processing Manual, Chapter 8, sections 20, 40, and 50.
January 29, 2026: MLN MM14359: Ambulatory Surgical Center Payment: January 2026 Update
This article provides information on updates effective January 1, 2026 related to new device categories, CPT codes, and HCPCS codes, drugs and biologicals, skin substitutes, and non-opioid treatments for pain relief. https://www.cms.gov/files/document/mm14359-ambulatory-surgical-center-payment-january-2026-update.pdf
February 20, 2026: MLN MM14371: Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: April 2026 Update
Make sure your billing staff knows about Clinical Laboratory Fee Schedule (CLFS) Updates including the next data reporting period for clinical diagnostic laboratory tests (CDLTs), and new CPT codes, effective April 1, 2026.
February 20, 2026: MLN MM14372: HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2026
Make sure your billing staff knows about discontinued codes, new codes, and codes subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits. https://www.cms.gov/files/document/mm14372-hcpcs-codes-clinical-laboratory-improvement-amendments-edits-april-2026.pdf
February 20, 2026: MLN MM14390: Vaccine Administration National Fee Schedule: April 2026 Udpate
Make sure your billing staff knows about the coding updated for TYENNE® (tocilizumab-aazg) for intravenous administration in hospitalized adults with COVID-19. https://www.cms.gov/files/document/mm14390-vaccine-administration-national-fee-schedule-april-2026-update.pdf
Coverage Updates
February 9, 2026: MLN MM14356: ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update
Make sure your billing staff knows about updates to the National Coverage Determinations (NDCs) with new or deleted ICD-10 diagnosis codes, effective July 1, 2026. NCDs with coding changes in Change Request (CR) 14356 include:
NCD 90.2 – Next Generation Sequencing (NGS)
NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis
NCD 150-13 – Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis
NCD 160.18 – Vagus Nerve Stimulation (VNS)
NCD 210.10 – Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs
NCD 220.6.17 – Positron Emission Tomography (PET) (FDG) for Oncologic Conditions
NCD 250.4 – Treatment of Actinic Keratosis
February 13, 2026: Change Request (CR) 14253: Update to Claims Processing Instructions for NCD 20.4 Implantable Cardiac Defibrillators (ICDs)
The purpose of this CR is to cover eleven procedure codes for the extravascular ICD (EV-ICD) system. https://www.cms.gov/files/document/r13641CP.pdf
February 17, 2026: MLN MM14302: National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension
This third iteration of this document was published to update the CR release date, transmittal numbers, and transmittal links. No substantive changes were made. https://www.cms.gov/files/document/mm14302-national-coverage-determination-20-40-renal-denervation-uncontrolled-hypertension.pdf
February 25, 2026: NCD 110.17 Anti-cancer Chemotherapy for Colorectal Cancer
CMS is removing this NCD. They noted in the final Decision Memo (CAG-00179R) “removing this NCD does not end the opportunity for coverage for these agents. Other coverage mechanisms exist including the Clinical Trial Policy NCD 310.12 and, separately, off-label use of anti-cancer chemotherapeutic agents are coverable according to §1861 (t)(2)(B) of the Social Security Act (the Act).” https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=320
Compliance Education Updates
December 2025: MLN Educational Tool: MLN006559: Medicare Preventive Services
CMS made changes to this Educational Tool in December 2025 to reflect changes in effect in 2026, including:
- Annual wellness visit: Updated description for HCPCS code G0136, effective January 1, 2026
- Medicare Diabetes Prevention Program:
- Added HCPCS code G9871, effective January 1, 2026
- Updated the extended flexibilities period to December 31, 2029
- Updated that sessions can also be held online through December 31, 2029
- Office and outpatient evaluation and management (E/M) visit FAQ: Starting January 1, 2026, you can bill G2211 as an add-on code with the home or residence E/M visits code family
January 2026: MLN Booklet: MLN909432: Behavioral Health Integration Services
This booklet has been updated to add three new optional add-on HCPCS codes for general behavioral health integration and psychiatric collaborative care model services when advanced primary care management services are provided. https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf
January 2026: MLN Booklet: MLN006398: Information for Rural Health Clinics
Several changes have been made to this booklet. For example, CMS has permanently adopted the definition of direct supervision to include supervision through audio-visual telecommunications technology. https://www.cms.gov/files/document/mln006398-information-rural-health-clinics.pdf
February 2026: MLN Fact Sheet: MLN3191598: Intravenous Immune Globulin Items & Services
This MLN Fact Sheet has been updated to include the CY 2026 payment rate for HCPCS code Q2052. https://www.cms.gov/files/document/mln3191598-intravenous-immune-globulin-items-services.pdf
February 2026: MLN Booklet: MLN34893002: Medicare Diabetes Prevention Program Expanded Model
Several changes were made to this MLN booklet with the February 2026 update. For example, the list or organization types that can become Medicare Diabetes Prevention Program (MDPP) suppliers has been expanded to include virtual-only organizations. https://www.cms.gov/files/document/mln34893002-medicare-diabetes-prevention-program-expanded-model.pdf
Other Updates
February 2, 2026: CMS Updates Telehealth FAQs
The consolidated Appropriations Act, 2026 signed into law on February 3, 2026, extends Medicare telehealth flexibilities through December 31, 2027. CMS updated their telehealth FAQ document on February 4, 2026. https://www.cms.gov/files/document/telehealth-faq-updated-02-04-2026.pdf
February 20, 2026: New MOON
The Office of Management and Budget (OMB) has reauthorized the Medicare Outpatient Observation Notice (MOON) (CMS-106611). Per CMS, “the MOON is effective now and expires February 28, 2029. Providers who have existing stock of the expired MOON may continue to use the expired version until April 20, 2026, but must transition to the new form no later than that date.”
https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative
February 25, 2026: Initiative Seeks Input on Strengthening Program Integrity to CRUSH Fraud
In a CMS press release, the White House, HHS, and CMS “announced new steps to crack down on fraud in Medicare and Medicaid to protect patients and taxpayers and improve affordability.” HHS Secretary Kennedy noted “we are replacing the old ‘pay and chase’ model with a real-time ‘detect and deploy’ strategy, using advanced AI tools to identify fraud instantly and stop improper payments before they go out the door.”
CMS is asking for input from stakeholders on ways to tackle fraud prevention to help with development of a likely future rule under CMS’ Comprehensive Regulations to Uncover Suspicious Health (CRUSH) initiative. For example, CMS is seeking input regarding reducing fraudulent Medicare Parts A and B claim submissions and have asked the question: “How would a claim filing deadline of 90 or 180 calendar days, which is consistent with private industry norms, impact your practice?”
Comments must be received by March 30, 2026.
CMS Press Release: https://www.cms.gov/newsroom/press-releases/trump-administration-prioritizes-affordability-announcing-major-crackdown-health-care-fraud
CMS Request for Information (RFI) Related to Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH): https://www.federalregister.gov/documents/2026/02/27/2026-03968/request-for-information-rfi-related-to-comprehensive-regulations-to-uncover-suspicious-healthcare
February 26, 2026: Therapy Services CY 2026 KX Modifier Threshold Amounts
The CY 2026 KX modifier threshold amount for CY 2026 is $2,480 for physical therapy and speech-language pathology combined, and occupational therapy services. You can find links to more information about therapy services in the February 26, 2026 edition of MLN Connects at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-february-26-2026.
Beth Cobb
2/12/2026
Medicare Transmittals & MLN Articles
January 9, 2025: Travel Allowance Fees for Specimen Collection: CY 2026 Updates
This article provides information about CY 2026 revised payment allowances for HCPCS code P9603, the updated general specimen collection fee and travel allowance rate, and the HCPCS/CPT codes that describe specimen collection. https://www.cms.gov/files/document/mm14345-travel-allowance-fees-specimen-collection-cy-2026-updates.pdf
Coverage Updates
January 22, 2026: Incorrect ICD-10 diagnosis code for Vagus Nerve Stimulation
In the January 22, 2026 edition of the CMS newsletter MLN Connects, they noted that ICD-10 diagnosis code G47.33 (Obstructive Sleep Apnea) was incorrectly included as a covered indication for CPT code 64568 under National Coverage Determination (NCD) 160.18. This NCD is specific to vagus nerve stimulation for medical refractory partial onset seizures for whom surgery is not recommended or for whom surgery has failed and treatment-resistant depression. It is unrelated to OSA and coverage from ICD-10 diagnosis code G47.33 falls under the Medicare Administrative Contractor’s (MAC’s) discretion and isn’t mandated by the NCD. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-january-22-2026
January 30, 2026: MLN MM14302: National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension
This MLN article was initially released in December 2025. CMS updated it due to adding claims processing instructions for outpatient bill type 13X and allowable place of service codes 19 and 22 for professional claims, and they specified you may only use CPT 0935T for professional claims.
The implementation date for these instructions is April 6, 2026. CMS notes that the MACs “will return any RDN claims you submitted with the wrong TOB, POS, condition Code, modifier, or value code or claims that don’t include the clinical trial number. Your MAC will deny claims you submitted without the appropriate ICD-10-CM diagnosis codes. Note: Your MAC won’t search their files for RDN claims processed with dates of service or discharge dates from October 28, 2025 – April 6, 2026; however, they’ll adjust any claims you bring to their attention. https://www.cms.gov/files/document/mm14302-national-coverage-determination-20-40-renal-denervation-uncontrolled-hypertension.pdf
Compliance Education Updates
MLN Booklet: MLN006400: Information for Critical Access Hospitals
CMS made several changes to this booklet in December 2025, for example information has been added about the Transforming Episode Accountability Model (TEAM) skilled nursing facility 3-day rule waiver. https://www.cms.gov/files/document/mln006400-information-critical-access-hospitals.pdf
MLN Fact Sheet: MLN2259384: Rural Emergency Hospitals
CMS updated this fact sheet in December 2025 by adding the CY 2026 payment amount. https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf
MLN Booklet: MLN907165: Medicare Vision Services
Changes were made to this booklet in December 2025, for example a list of Medicare covered diseases for intravitreal injections was added and includes (neovascular (wet) age-related macular degeneration, macular edema following retinal vein occlusion, diabetic macular edema, and diabetic retinopathy). https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/visionservices_factsheet_icn907165.pdf
On a related note, the OIG published a report in May 2025 focused on Medicare payments for Evaluation and Management (E&M) services provided on the same day as eye injections at risk for noncompliance with Medicare requirements. Based on the audit findings, the OIG recommended that CMS update requirements for billing E&M services provided on the same day as intravitreal injections to help providers understand appropriate use of modifier 25, conduct medical reviews of E&M services, and recover payments of up to $124 million for those services that CMS determines should not have been billed with modifier 25 during the audit period (June 2022 through May 2023). https://oig.hhs.gov/documents/audit/10286/A-09-23-03014.pdf
Medicare Wellness Visits – New Webpage
CMS’ Medicare Wellness Visits MLN product is now a CMS.gov webpage. In the January 22, 2026 edition of MLN Connects they are changing some Medicare Learning Network® (MLN) products to webpages to improve user experience and content accessibility. https://www.cms.gov/medicare/coverage/preventive-services/medicare-wellness-visits
MLN Booklet: MLN901705: Telehealth & Remote Monitoring
CMS updated this booklet in December 2025. Several things have changed. For example, CMS permanently allows teaching and supervising physicians to supervise through virtual presence and 5 new CPT and HCPCS codes have been added to the Medicare telehealth services list. https://www.cms.gov/files/document/mln901705-telehealth-remote-monitoring.pdf
Other Updates
January 15, 2026: CMS Fact Sheet: Fiscal Year 2025 Improper Payments Fact Sheet
CMS opens this fact sheet by reminding the reader that CMS’ improper payment measurement is not a measure of fraud, and improper payments are not attributable to fraud and abuse. Instead, improper payments are payments that do not meet CMS program documentation, coding, and/or billing requirements. The estimated improper payment rate for Medicare Fee-for-Service (FFS) for FY 2025 was 6.55%, or $23.83 billion which is decreased from FY 2024’s estimated rate of 7.66%, or $31.70 billion. Unlike FFS, the improper payment rate for Medicare Part C or Medicare Advantage increased from $19.07 billion in FY 2024 to $23.67 billion in FY 2025. https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-improper-payments-fact-sheet
Beneficiary Notices MOON, IM, and DND Expired in 2025: Guidance from CMS
The Medicare Outpatient Observation Notice (MOON) (CMS-10611) expired on November 30, 2025 and the Important Message from Medicare (IM) (CMS-10065) and the Detailed Notice of Discharge (DND) (CMS-1066) expired December 31, 2025. As of the end of January 2026 new forms are not available. While we wait for CMS to work with the OMB to reauthorize this information collection, providers may continue to use the current version of the notices until CMS provides further instructions. When the forms are available, CMS has indicated they will notify the industry through their website, the Health Plan Management System (HPMS), and the Medicare Learning Network. At that time, providers will have 60 calendar days from the date of the CMS announcement to begin using the updated MOON, IM/DND. https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiativeBeth Cobb
1/14/2026
Medicare Transmittals & MLN Articles
November 24, 2025: MLN MM14250: Therapy Code List: 2026 Annual Update
Make sure your billing staff knows about updates effective January 1, 2026, for remote therapeutic monitoring (RTM) services designated as sometimes therapy. https://www.cms.gov/files/document/mm14250-therapy-code-list-2026-annual-update.pdf
December 5, 2025: MLN MM14279: Medicare Deductible, Coinsurance & Premium Rates: CY 2026 Update
This article provides information for CY 2026 Medicare Part A and Medicare Part B deductible, coinsurance rates, and premiums. https://www.cms.gov/files/document/mm14279-medicare-deductible-coinsurance-premium-rates-cy-2026-update.pdf
December 9, 2025: MLN MM14315: Medicare Physician Fee Schedule Final Rule Summary; CY 2026
Make sure your billing staff knows about updated payment rates and policies for FY 2026. https://www.cms.gov/files/document/mm14315-medicare-physician-fee-schedule-final-rule-summary-cy-2026.pdf
December 12, 2025: Inpatient Psychiatric Facilities Prospective Payment System: FY 2026 Updates
Make sure billing staff know about the FY 2026 updates including facility-level adjustment factors, market basket, wage index, quality reporting programs (QRP), and rural adjustment. https://www.cms.gov/files/document/mm14206-inpatient-psychiatric-facilities-prospective-payment-system-fy-2026-updates.pdf
December 31, 2025: Transmittal 13570: Implementation of WISeR Model Prior Authorization and Medical Review Process and Establishment of New Quarterly Change Request Process
Transmittal Summary: The purpose of this Change Request (CR) is to implement the Wasteful and Inappropriate Service Reduction (WISeR) Model Prior Authorization and Medical Review Process starting January 1, 2026, and establish a recurring quarterly process to allow for updates to attachment file contents as needed. https://www.cms.gov/files/document/r13570demo.pdf
Coverage Updates
December 8, 2025: Anti-Cancer Chemotherapy for Colorectal Proposed Decision Memo (CAG-00179R)
CMS is proposing to remove NCD 110.17 for Anti-cancer Chemotherapy for Colorectal Cancer and notes that “removing this NCD would not end the opportunity for coverage for these agents.” The public comment period is from December 8, 2025 to January 7, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=320
December 11, 2025: MLN MM14263: ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2026 Update
CMS advises that you make sure your billing staff know about CPT additions to the NCD: Sacral Nerve Stimulation for Urinary Incontinence (230.18), effective June 17, 2025. https://www.cms.gov/files/document/mm14263-icd-10-other-coding-revisions-national-coverage-determinations-april-2026-update.pdf
December 11, 2025: MLN MM14253: Adding Extravascular Defibrillator Codes to National Coverage Determination 20.4: Implantable Cardiac Defibrillators
Make sure your billing staff knows about changes to NCD 20.4 including coverage of additional procedure codes for the Aurora™ extravascular ICD (EV-ICD) system, effective October 20, 2023, and updates to the coding requirements. https://www.cms.gov/files/document/mm14253-adding-extravascular-defibrillator-codes-national-coverage-determination-20-4-implantable.pdf
December 12, 2025: MLN MM14204: Chimeric Antigen Receptor T-Cell Therapy Claims: End of Risk Evaluation Mitigation Strategy (REMS) & KX Modifier Requirement
As of June 26, 2025, CMS no longer requires providers to administer CAR T-cell therapy in an FDA REMS approved facility or the KX modifier on Part B claims. https://www.cms.gov/files/document/mm14204-chimeric-antigen-receptor-t-cell-therapy-claims-end-risk-evaluation-mitigation-strategy-kx.pdf
December 15, 2025: NDC 20.32: Transcatheter Aortic Valve Replacement (TAVR) National Tracking Analysis
CMS accepted a formal request from Edwards Lifesciences to initiate a reconsideration of this NCD focused on coverage of TAVR for Aortic Stenosis (AS) in symptomatic and asymptomatic patients. The public comment period is from December 15, 2025 to January 14, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=321
December 17, 2025: December 2025 National Coverage Determination (NCD) Dashboard
In this edition of the NCD Dashboard there are 3 open NCDs, 6 NCDs finalized in the past 12 months, 1 pending Transitional Coverage for Emerging Technologies (TCET) topic and 10 accepted NCD requests on the wait list. https://www.cms.gov/files/document/ncddashboard-2025.pdf
December 19, 2025: MLN Matters MM14302: National Coverage Determination 20.40 Renal Denervation for Uncontrolled Hypertension
Effective October 28, 2025, CMS covered Renal Denervation (RDN) for treating uncontrolled hypertension under coverage with evidence development (CED). Make sure your staff knows about the NCD criteria, CED study criteria, and claims processing requirements. https://www.cms.gov/files/document/mm14302-national-coverage-determination-20-40-renal-denervation-uncontrolled-hypertension.pdf
December 22, 2025: MLN MM14311: Cardiac Contractility Modulation for Heart Failure
Effective October 28, 2025, CMS covers Cardiac Contractility Modulation (CCM) for treating heart failure (HF) under CED according to the coverage criteria in NCD 20.39. Make sure your billing staff knows about the national coverage for CCM including the criteria, CED study criteria, and clams processing requirements. https://www.cms.gov/files/document/mm14311-cardiac-contractility-modulation-heart-failure.pdf
December 24, 2025: Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes Withdrawn
CMS published a fact sheet indicating that effective immediately, the A/B MACs are withdrawing the LCDs for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers that were scheduled to become effective on January 1, 2026. https://www.cms.gov/newsroom/fact-sheets/upcoming-update-final-local-coverage-determinations-lcds-certain-skin-substitutes
Compliance Education Updates
Medicare Preventive Services – Revised
CMS has made changes to information related to colorectal cancer screening tests, COVID-19 vaccine and administration, PrEP using antiretroviral therapy to prevent HIV infection, and screening pap test and screening pelvic exam. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
Medicare Provider Compliance Tips is now a CMS.gov Webpage
CMS has updated several compliance tips based on the improper payment rate and denial reasons for the 2024 reporting period. You can learn more about the services that have been updated and find a link to the new CMS webpage in the Thursday December 18, 2025, edition of CMS’ MLN Connects Newsletter. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-december-18-2025#_Toc216870507
Other Updates
December 4, 2025: Medicare Appeals: Adjustments to the Amount in Controversy Threshold Amounts for CY 2026
CMS published a notice 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 January 1, 2026 the ALJ hearings AIC will increase from $190 in CY 2025 to $200 for CY 2026, and the Federal District Court reviews AIC will increase from $1,900 in CY 2025 to $1,960 for CY 2026. Link to Federal Register announcement: https://www.govinfo.gov/content/pkg/FR-2025-12-04/pdf/2025-21879.pdf
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December 17, 2025: ICD-10-PCS Codes Effective April 1, 2026
CMS is implementing 80 new procedure codes, effective April 1, 2026. These codes will be used for discharged occurring from April 1, 2026 – September 30, 2026. Sixteen of the procedure codes are new technology group 11 codes. https://www.cms.gov/medicare/coding-billing/icd-10-codes
The ICD-10 MS-DRG Version 43.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits Version 43.1 Manual to accommodate these new procedure codes will be available February 1, 2026 at: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software
Beth Cobb
12/23/2025
Background
What is PEPPER: “PEPPER is an electronic data report that contains a single hospital’s claims data statistics for Medicare Severity Diagnosis Related Groups (MS DRGs) and discharges at risk for improper payment due to billing, coding, and/or admission necessity issues… PEPPER does not identify the presence of payment errors, but it can be used as a guide for auditing and monitoring efforts. A hospital can use PEPPER to compare its claims data over time to identify potential areas of concern, including significant changes in billing practices; possible over- or under-coding; and changes in length of stay.” ¹
PEPPER Target Areas: “In general, the target areas are constructed as ratios and expressed as percents; the numerator represents discharge that have been identified as problematic, and the denominator represents discharges of a larger comparison group.” ¹
Program Paused: In January 2024, CMS temporarily paused PEPPER to "improve and update the program reporting system."
Program Resumption Key Takeaways
August 2025: A notice on the PEPPER website indicated “The site is currently testing with select PEPPER recipients and PEPPER Portal access is limited to these users. Thank you for your patience and please check back soon for updates on full availability.” Index Analytics (IA), and its partners Integrity Management Services, Inc. and GovCon Growth Solutions were listed in a limited release PEPPER User’s Guide as being under contract with CMS to develop and distribute the PEPPER.
December 10, 2025: A PEPPER Short-Term Acute Care User’s Guide was released.
What’s New in December 2025 PEPPER Short-Term Acute Care User’s Guide
As compared to the 36th Edition of the User’s Guide, the same Target Area’s continue to be active for FY 2025. However, two Target Areas were impacted due to changes to the Percutaneous Cardiovascular Procedures DRGs effective October 1, 2023.
Target Area: Surgical Complication and Comorbidity (CC) Major Complication and Comorbidity (MCC) modification as of Quarter 1 (Q1) of Fiscal Year (FY) 2024 (Q1FY2024)
DRGs 246 and 248 were removed and replaced with the following two new DRGs effective October 1, 2023:
DRG 321: Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ Arteries/Intraluminal Devices, and
DRG 322: Percutaneous cardiovascular procedures with intraluminal device without MCC.
Target Area: Percutaneous Cardiovascular Procedures modification as of Q1FY 2024
DRGs 246, 247, 248, and 249 were removed and replaced with the above 2 new DRGs listed above (321 and 322).
PEPPER User’s Guide Suggested Intervention for Outliers
While there are no new Target Areas, I want to call your attention to the Target Area Respiratory Infection. If you are a high outlier, Table 3 of the User’s Guide lists the following suggestions:
- This could indicate potential coding or billing errors related to over-coding for DRGs 177 or 178.
- Review a sample of medical records for these DRGs to determine whether coding errors exist.
- To ensure documentation supports the principal diagnosis, hospitals may generate data profiles to identify cases with the following principal diagnosis codes:
- International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10-CM) code J69.0 (pneumonitis due to inhalation of food or vomit)
- ICD-10-CM code J15.69 (Pneumonia due to other Gram-negative bacteria)
- ICD-10-CM code J15.8 (pneumonia due to other specified bacteria)
The User’s Guide does not include information regarding COVID-19. Specifically, when the COVID-19 ICD-10-CM code U07.1 is the principal diagnosis, a claim will group to the DRG group 177,178, and 179. Analysis of RealTime Medicare Data (RTMD) Medicare Fee-for-Service paid claims data tells us that in the first three quarters of the CMS FY 2025 (October 1, 2024 – June 30, 2025):
- Nationwide, DRGs 177 and 178 represented 34.97% of all volume for the six Respiratory Infections Target Area denominator DRGs (see Table 1), and
- ICD-10-CM diagnosis code U07.1 represented 41.95% of all volume for DRGs 177 and 178 (see Tables 2 and 3).
If you are a high outlier for this Target Area, a first step may be to identify the percentage of your claims where ICD-10-CM code U07.1 was the principal diagnosis.
For more information about the relaunch of PEPPER, CMS hosted a webinar on January 6, 2026 to provide guidance on recent changes, review reports and provide a Q&A session. This event was recorded and will be made available on the PEPPER website (https://pepper.cbrpepper.org/index.html) shortly thereafter.
Reference: ¹ Short-term Acute Care Hospitals December 2025 PEPPER User’s Guide accessed 12/16/2025 from https://pepper.cbrpepper.org/training-short-term-acute-care.html
Appendix A: RTMD Medicare FFS Paid Claims Data for Dates of Service October 1, 2024 to June 30, 2025
Table 1: Nationwide Claims Volume for All DRGs in Respiratory Infections Target Area Denominator
|
DRG and Description |
Volume |
% of Volume |
|
177-RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC |
89,508 |
28.25% |
|
178-RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC |
21,299 |
6.72% |
|
179-RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC |
3,688 |
1.16% |
|
193-SIMPLE PNEUMONIA AND PLEURISY WITH MCC |
140,825 |
44.45% |
|
194-SIMPLE PNEUMONIA AND PLEURISY WITH CC |
51,734 |
16.33% |
|
195-SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC |
9,764 |
3.08% |
|
Grand Total |
316,818 |
100.00% |
Table 2: Percentage of DRG 177 Claims with COVID-19 Principal Diagnosis
|
DRG 177-RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC |
Volume |
% of Volume |
|
U07.1-COVID-19 |
37,367 |
41.75% |
|
Grand Total all DRG 177 claims |
89,508 |
100.00% |
Table 3: Percentage of DRG 178 Claims with COVID-19 Principal Diagnosis
|
DRG 178-RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC |
Volume |
% of Volume |
|
U07.1-COVID-19 |
9,116 |
42.80% |
|
Grand Total all DRG 178 claims |
21,299 |
100.00% |
Beth Cobb
12/23/2025
Medicare Transmittals & MLN Articles
September 23, 2025: MLN MM14246: Ambulatory Surgical Center Payment System: October 2025 Update
CMS details payment system updates effective October 1, 2025 in the ASCs. For example, new hospital outpatient prospective payment system (OPPS) device pass-through category payable in ASCs. https://www.cms.gov/files/document/mm14246-ambulatory-surgical-center-payment-system-october-2025-update.pdf
September 25, 2025: MLN MM14223: Hospital Outpatient Prospective Payment System: October 2025 Update
This MLN article includes updates effective October 1, 2025. For example, new COVID-19 monoclonal antibody and pleural-peritoneal shunt HCPCS codes, and status indicator updates. https://www.cms.gov/files/document/mm14223-hospital-outpatient-prospective-payment-system-october-2025-update.pdf
September 29, 2025: MLN MM14098: Implementing the Transforming Episode Accountability Model: Skilled Nursing Facility 3-Day Rule Waiver
This Transforming Episode Accountability Model (TEAM) will run from January 1, 2026 to December 31, 2030. There were no substantive changes to this third iteration of this MLN article. As a reminder for participating hospitals in this model, “CMS will allow acute care hospitals who participate in the model to discharge patients without a 3-day hospital stay to a qualified SNF or swing bed provider, including a CAH.” https://www.cms.gov/files/document/mm14098-implementing-transforming-episode-accountability-model-skilled-nursing-facility-3-day-rule.pdf
You can visit the CMS.gov TEAM webpage to learn more about this mandatory model. https://www.cms.gov/priorities/innovation/innovation-models/team-model
November 21, 2025: MLN MM14215: Implementing the Transforming Episode Accountability Model: Telehealth Waiver
CMS provides details regarding telehealth services under the TEAM (Transforming Episode of Accountability Model) with dates of service on or after January 1, 2026. As a reminder, this is a mandatory model that will run for five performance years from January 1, 2026, to December 31, 2030, in selected Core-Based Statistical Areas nationwide.
Link to MLN Article: https://www.cms.gov/files/document/mm14215-implementing-transforming-episode-accountability-model-telehealth-waiver.pdf
Link to learn more about TEAM: https://www.cms.gov/priorities/innovation/innovation-models/team-model
November 21, 2025: MLN MM14219: Outpatient Services for Hospice Patients: New Edit
CMS has “created a new edit to automatically compare the outpatient claim’s primary diagnosis with the hospice claim’s primary diagnosis codes by doing an exact diagnosis match. This edit will deny hospital inpatient and outpatient claims when there’s a hospice claim for the same Medicare patient within the same covered period with condition code 07 or modifier GW with the same principal diagnosis.” Make sure your billing staff know about new systems’ edits that will compare primary diagnosis codes on hospital and hospice claims for Medicare hospice patients to prevent duplicate payments and how to use condition code 07. https://www.cms.gov/files/document/mm14219-outpatient-services-hospice-patients-new-edit.pdf
Coverage Updates
October 28, 2025: Final National Coverage Determination (NCD): Cardiac Contractility Modulation (CCM) for Heart Failure
CMS’ final decision is that CCM for heart failure (HF) management is covered under Coverage with Evidence Development (CED) according to sections (B) Coverage Criteria and (C) Other Uses of CCM. https://www.cms.gov/files/document/id317a.pdf-0
October 28, 2025: Final NCD: Renal Denervation for Uncontrolled Hypertension
CMS’ final decision is that radiofrequency renal denervation (rfRDN) and ultrasound renal denervation (uRDN) (collectively, RDN) for uncontrolled hypertension is covered under CED. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=318
Compliance Education Updates
September 2025: MLN Educational Tool (MLN6922507): Medicare Payment Systems
The Acute Care Hospital Inpatient Prospective Payment System section of this tool was updated to include FY 2026 changes. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/medicare-payment-systems.html#Acute
September 2025: MLN Fact Sheet (MLN900943): Health Care Code Sets
This MLN Fact Sheet was updated to include information about National Drug Codes (NDCs) in the code sets table. https://www.cms.gov/files/document/mln900943-health-care-code-sets.pdf
Other Updates
September 2025: Joint Commission Goals Starting in 2026: New – Nurse Staffing as Core Component of Quality
Effective January 1, 2026, National Performance Goals (NPGs) are replacing National Patient Safety Goals. The Joint Commission notes this is “a new chapter that organizes requirements that rise above regulation (excluding the “Medical Staff” (MS) chapter) into salient, measurable topics with clearly defined goals. NPGs are available for the Hospital and Critical Access Hospital accreditation programs.” For the first time, nurse staffing is a core component in Goal 12.02.01 – EP 5 which states “there must be an adequate number of licensed registered nurses, licensed practical (vocational) nurses, and other staff to provide nursing care to all patients, as needed.” https://www.jointcommission.org/en-us/standards/national-performance-goals
October 22, 2025: Acentra Health Special Bulletin: Higher-Weighted DRG (HWDRG) Reviews
Previously Livanta, the National Claim Review Contractor, completed short stay reviews (SSRs) and higher-weighted DRG (HWDRG) reviews nationwide. Livanta’s contract concluded August 11, 2025. As of September 1, 2025, the Medicare Administrative Contractors (MACs) assumed responsibility for pre-payment SSRs.
Acentra Health’s special bulletin provides information about HWDRG reviews now being completed by the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) according to their regional assignments. Acentra noted they would soon begin requesting medical records for these reviews. You can read more about this on their HWDRG reviews webpage at https://www.acentraqio.com/providers/hwdrg.
October 31, 2025: CMS Releases CY 2026 Physician Fee Schedule (PFS) Final Rule
Specific to telehealth services, CMS finalized streamlining the process for adding services to the Medicare Telehealth Services List by simplifying the review process by removing the distinction between provision and permanent services and limited their review on whether the service can be furnished using an interactive, two-way audio-video telecommunication system. You can read more about the final rule in a CMS Fact Sheet at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f.
November 14, 2025: 2026 Medicare Parts A & B Premium and Deductibles
CMS published a Fact Sheet releasing the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Part D income-related monthly adjustment amounts. For example, the Inpatient Hospital Deductible: Is increasing $60 from $1,676 in 2025 to $1,736 in 2026. You can read about other changes in the CMS Fact Sheet at
https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles.
November 20, 2025: CMS Released CY 2026 ESRD Prospective Payment System (PPS) Final Rule
CMS notes for CY 2026 the ESRD PPS base rate will increase to $281.71 and total payments to all ESRD facilities, both freestanding and hospital-based, are expected to increase by approximately 2.2%. You can read more about the final rule in a related CMS Fact Sheet at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-end-stage-renal-disease-esrd-prospective-payment-system-final-rule.
November 21, 2025: CMS Releases CY 2026 Outpatient Prospective Payment System (OPPS) / Ambulatory Surgical Center (ASC) Final Rule
In this final rule CMS finalized the elimination of the Inpatient Only List over three years with 285 mostly musculoskeletal procedures being removed for CY 2026. At the same time 271 of the 285 codes are being added to the ASC Covered Procedure List (CPL) as well as 289 additional procedures that were not on the IPO list.
CY 2026 OPPS/ASC Final Rule Resources
CMS Press Release: https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-boosts-transparency-modernizing-hospital-payments
CY 2026 OPPS Final Rule CMS webpage: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc
CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center
Hospital Price Transparency Policy Changes Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes
Medicare and You 2026 Edition Now Available
Medicare and You is the official U.S. government Medicare handbook. The 2026 version is now available. CMS noted in the November 20, 2025 edition of MLN Connects new and important items this year includes:
- Capping yearly out-of-pocket Part D prescription drug costs,
- Meeting health care needs with Advanced Primary Care Management services,
- Detecting colon cancer early through a wide range of screenings, and
- Information to help fight fraud and cut waste.
You can download your copy today at: https://www.medicare.gov/publications/10050-medicare-and-you.pdf.
Beth Cobb
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