Medicare News


Medicare News includes information for health care professionals about Medicare programs, policies and initiatives. Use these resources to stay up-to-date about current and planned Medicare changes.

Palmetto GBA maintains links to recently released and revised Centers of Medicare & Medicaid Services (CMS) MLN® articles. All MLN Matters articles will continue to be available on the CMS MLN Matters website. MLN Connects® will contain Medicare related messages from CMS. These messages ensure planned, coordinated messages are delivered timely about Medicare related topics.





Medicare News Articles


March 2020 Medicare AdvisoryJuly 2019 Medicare AdvisoryDecember 2019 Medicare AdvisoryNovember 2020 Medicare AdvisoryAugust 2020 Medicare AdvisoryOctober 2020 Medicare AdvisoryApril 2020 Medicare AdvisoryApril 2019 Medicare AdvisoryJune 2020 Medicare AdvisoryMay 2020 Medicare AdvisoryFebruary 2020 Medicare AdvisoryJuly 2020 Medicare AdvisorySeptember 2019 Medicare AdvisoryJanuary 2020 Medicare AdvisoryJune 2019 Medicare AdvisoryMay 2019 Medicare AdvisoryAugust 2019 Medicare AdvisoryOctober 2019 Medicare AdvisoryNovember 2019 Medicare AdvisorySeptember 2020 Medicare AdvisoryDecember 2020 Medicare AdvisoryProper Coding for Specimen Validity Testing Billed in Combination with Drug TestingAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 87811 and 87428Guidance on Coding and Billing Date of Service on Professional ClaimsProvider Enrollment - Unlicensed ResidentsAdvanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 WebsiteInternet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19April 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemBilling for Home Infusion Therapy Services On or After January 1, 2021Update to Chapter 10 of Publication (Pub.) 100-08 - Enrollment Policies for Home Infusion Therapy (HIT) SuppliersPre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention ProgramIncorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any TypeUpdating Calendar Year (CY) 2021 Medicare Diabetes Prevention Program (MDPP) Payment RatesCurrent Medicare Coverage of Diabetes SuppliesQuarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 27.1, Effective April 1, 2021Foot Care Coverage GuidelinesMedically Unlikely Edits (MUE) and Bilateral Surgical ProceduresUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021Palmetto GBA B Notice or 1099 Request FormCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersAnnual Clotting Factor Furnishing Fee Update 2021Claim Status Category and Claim Status Codes UpdatesHow often does CMS update the Medicare Revalidation List due date information?Next Generation Accountable Care Organization - ImplementationProper Use of Modifier 59How to Use the Medicare Coverage DatabaseProhibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramSection 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicareAmbulance Inflation Factor (AIF) for Calendar Year (CY) 2021 and Productivity AdjustmentRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 UpdateReminder on Billing Requirements Implemented for non-OPPS ProvidersMLN Connects Special Edition - Monday, December 14, 2020Claim Status Category and Claim Status Codes UpdateMLN Connects Special Edition - Monday, December 28, 2020Please Do Not Email Protected Health Information (PHI)Medicare Clarifies Recognition of Interstate License CompactsFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsValue-Based Insurance Design (VBID) Model - Implementation of the Hospice Benefit ComponentFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsNational Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 20202021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsNew Waived Tests2021 Annual Update to the Therapy Code ListOctober 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesEducational Resources to Assist Chiropractors with Medicare BillingHealth Professional Shortage Area (HPSA) - Improper Use of the AQ HCPCS Modifier May Reduce Cash FlowMLN Connects Special Edition - Wednesday, December 9, 2020MLN Connects Special Edition - Friday, December 18, 2020: COVID-19: Add-on Payment for New Treatments.New Physician Specialty Code for Micrographic Dermatologic Surgery (MDS) and Adult Congenital Heart Disease (ACHD) and a New Supplier Specialty Code for Home Infusion Therapy ServicesMLN Connects for Thursday, January 7, 2021Claim Status Category and Claim Status Codes UpdateMLN Connects for Thursday, January 14, 2021October 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemNational Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingCY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleMLN Connects for Thursday, January 28, 2021MLN Connects for Thursday, February 25, 2021Medicare Advantage (MA) Plans Adherence to Local and National Coverage Determination InquiriesImplement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) COREIdentify a Medicare Advantage PlanProvider ResponsibilityRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs)-January 2021 UpdateMLN Matters Article 12093 Outlines Use of CLIA Waiver Modifier for Two CodesApril 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2020 UpdateMLN Connects Special Edition - January 7, 2021Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)MLN Connects for Thursday, February 18, 2021Accepting Payment from Patients with a Medicare Set-Aside ArrangementReview of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)Provider Compliance Tips for Polysomnography (Sleep Studies) - RevisedImplement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) COREBeneficiary Signature RequirementsStandard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization RequirementsJuly 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesJuly Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleNCD 20.4 Implantable Cardiac Defibrillators (ICDs)Overview of the Patient Driven Groupings ModelMLN Connects Special Edition - Thursday, December 10, 2020Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateMLN Connects Special Edition - Friday, December 18, 2020Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentMLN Connects for Thursday, February 4, 2021Local Coverage Determinations (LCDs)International Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - April 2021Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 UpdateMLN Connects for Thursday, February 11, 2021Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementOctober Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleNational Coverage Determination (NCD 90.2): Next Generation Sequencing (NGS) for Medicare Beneficiaries with Germline (Inherited) CancerAdd Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCSPayments and Payment Adjustments under the Patient-Driven Groupings ModelRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateAlpha-Numeric HCPCSNational Coverage Determination (NCD 90.3): Chimeric Antigen Receptor (CAR) T-cell TherapyMLN Connects for Thursday, March 4, 2021Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable ChargeA Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019New Waived TestsUpdate to the Medicare Claims Processing ManualMedicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemManual Update to Pub. 100-04, Chapter 38, to Remove Identification of Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico SectionJuly 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemSummary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services ListBilling for Services when Medicare is a Secondary PayerTherapy Codes UpdateQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 UpdateImplement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) COREImplement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) COREMLN Connects for Thursday, December 17, 2020NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR)Submit Medical Record Documentation via esMDAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsTelehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - ImplementationNational Coverage Determination (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM)January 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files2021 Annual Update of Per-Beneficiary Threshold AmountsNew Waived TestsInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2020 UpdateApril 2020 Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesApril Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesMedicare Coverage for Chiropractic Services - Medical Record Documentation Requirements for Initial and Subsequent Visits2021 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) UpdateInfluenza Vaccine Payment Allowances - Annual Update for 2020-2021 SeasonMLN Connects for Thursday, January 21, 2021Medicare Advantage Plan Directory (CMS website)Entering Beneficiary Information: eServices Eligibility Inquiry vs. Claim SubmissionSubmitting Additional Documentation to Palmetto GBAMasking of Patient Control Number/Patient Account Number Field on Paper Remittance Advice Began October 1, 2019COVID-19 Vaccines and Monoclonal Antibodies Administration AllowancesNational Correct Coding Initiative (NCCI) ToolIntensive Behavioral Therapy (IBT) for ObesityProcedure Codes that Require Additional DocumentationSubmitting Additional DocumentationInstructions for Completing the Medicare PWK Fax Cover Sheet When Submitting Additional DocumentationAppropriate Usage of the Modifier for a Distinct Procedural Service, Other Than E/M ServicesSplit/Shared Visits in Inpatient Hospital or Emergency DepartmentMedicare's Telehealth Benefit: Clarification from the Durable Medical Equipment MACs2019 Payment Adjustment RemindersPhysicians, Are You Ordering Glucose Monitors and Supplies for Your Patients?Did You Know DME MACs Offer Resources for Physicians?Physicians! Are You Ordering Oxygen for Your Patient?Provider Contact CenterUnlisted and Not Otherwise Classified Procedure Codes (NOC)Fraud Alert: Genetic Testing ScamLooking for Medicare Coverage Information?Polysomnography (Sleep Study)Important Tax Information - 1099 FormsWays to Connect to Palmetto GBABilling Instructions for Investigational Device Exemptions (IDEs)Unsolicited Fax or Email Inquiry'What If' and Scenario QuestionsOpen Draft Local Coverage Determination (LCD) MeetingAlcohol Misuse Screening and CounselingBankruptcyJurisdiction J (JJ) Local Coverage Determination (LCD) NotificationHCPCS Code G2211 is a Bundled Service and Not Separately PaidHow To Recognize an SMRC AuditFederally Qualified Health Center or Rural Health ClinicsMedicare Provider Alert - Your Responsibility When Using OutsourcersLocal Coverage Determinations: Find Them QuicklyCMS Advanced Care Planning FAQsFOIA RequestsCare Plan Oversight ServicesMedicare Part B 2021 Final Rule: Evaluation and Management Changes - IntroductionHome Health ReferralsCorrect Date of Service for Specific ServicesMLN Connects Special Edition - Wednesday, March 10, 2021MLN Connects for Thursday, December 10, 2020Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print UpdateQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentClinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of SpecimensApril Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleSave Time with eTicket ModuleMLN Connects Special Edition - Tuesday, December 22, 2020Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentMLN Connects for Wednesday, December 23, 2020Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final RulesAddition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsCertifying Patients for the Medicare Home Health BenefitCMS Open Payments Data WebsiteNew Medicare Beneficiary Identifier (MBI) Get It, Use ItThe Stage 1 Meaningful Use Attestation CalculatorMedicare Quality Reporting Incentive programs ManualsZIP Codes Eligible for HPSA Surgical Incentive Payment Program (HSIP) PaymentCMS Claim Filing InstructionsUpdated Billing Requirements for Home Infusion Therapy (HIT) Services on or After January 1, 2021Collecting From Medicare PatientsMandatory Claims Filing RequirementsEligibility for Medicare: BeneficiariesFraud and AbuseServices Outside the United States'Incident To' and Nonphysician Practitioner ServicesTeaching PhysiciansDenials Under the Medicare ProgramImportant Information on the Timely Claims Filing RequirementFederal Regulations: Anti-Kickback and Self-ReferralFee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements)Signature Requirements on Claims: Medicare PatientsRemittance AdviceWhat Is Covered Under Medicare Part BAbout MedicareProvider Self Service ApplicationsHealth Professional Shortage AreasMLN Connects for Thursday, April 1, 2021MLN Connects Special Edition - Tuesday, March 30, 2021MLN Connects Special Edition - Monday, March 15, 2021MLN Connects for Thursday, March 18, 2021MLN Connects for Thursday, March 25, 2021MLN Connects for Thursday, March 11, 2021Claims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)New Provider Enrollment Administrative Action AuthoritiesUpdate to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B ServicesRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementMLN Connects newsletter for Thursday, April 8, 2021Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 27.2, Effective July 1, 2021April 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemTop Time-Saving Tools for Palmetto GBA ProvidersMLN Connects Special Edition - Thursday, April 8, 2021MLN Connects Special Edition - Wednesday, April 14, 2021MLN Connects for Friday, April 16, 2021Common Working File (CWF) Edits for Medicare Telehealth Services and Manual UpdateAssisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)January 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs): July 2021MLN Connects Special Edition: Tuesday, April 20, 2021MLN Connects for Thursday, April 22, 2021Health Care Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsSpecial Provisions for Radiology Additional Documentation RequestsMLN Connects Special Edition: Tuesday, April 28, 2021July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesNew Waived TestsAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87636MLN Connects for Thursday, April 29, 2021ePass is Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA's Provider Contact CenterCognitive Assessment & Care Plan ServicesMLN Connects for Thursday, May 6, 20212021 Provider Contact Center Training and Holiday Closure ScheduleMLN Connects Special Edition: Tuesday, May 11, 2021If You've Contacted Us Recently, We Would Love to Hear About Your Experience!October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement2021 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction ListeTicket Enables Providers to Save Time with Every CallMLN Connects for Thursday, May 13, 2021