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.




November 2020 Medicare AdvisoryAugust 2020 Medicare AdvisoryOctober 2020 Medicare AdvisoryJune 2020 Medicare AdvisoryJuly 2020 Medicare AdvisorySeptember 2020 Medicare AdvisoryDecember 2020 Medicare AdvisoryProper Coding for Specimen Validity Testing Billed in Combination with Drug TestingGuidance 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 19Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention ProgramIncorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any TypeCurrent Medicare Coverage of Diabetes SuppliesFoot Care Coverage GuidelinesMedically Unlikely Edits (MUE) and Bilateral Surgical ProceduresPalmetto GBA B Notice or 1099 Request FormCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersHow 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 MedicareReminder on Billing Requirements Implemented for non-OPPS ProvidersPlease Do Not Email Protected Health Information (PHI)FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsEducational Resources to Assist Chiropractors with Medicare BillingHealth Professional Shortage Area (HPSA) - Improper Use of the AQ HCPCS Modifier May Reduce Cash FlowMedicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingMedicare Advantage (MA) Plans Adherence to Local and National Coverage Determination InquiriesIdentify a Medicare Advantage PlanMLN Matters Article 12093 Outlines Use of CLIA Waiver Modifier for Two CodesUse of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)Accepting 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) - RevisedBeneficiary Signature RequirementsNCD 20.4 Implantable Cardiac Defibrillators (ICDs)Overview of the Patient Driven Groupings ModelMedicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentLocal Coverage Determinations (LCDs)Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementPayments and Payment Adjustments under the Patient-Driven Groupings ModelAlpha-Numeric HCPCSA Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019Billing for Services when Medicare is a Secondary PayerSubmit Medical Record Documentation via esMDAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesMedicare 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 ObesitySubmitting 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 ServicesMedicare'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)Looking for Medicare Coverage Information?Polysomnography (Sleep Study)Important Tax Information - 1099 FormsBilling Instructions for Investigational Device Exemptions (IDEs)Unsolicited Fax or Email InquiryOpen Draft Local Coverage Determination (LCD) MeetingAlcohol Misuse Screening and CounselingBankruptcyJurisdiction J (JJ) Local Coverage Determination (LCD) NotificationHow To Recognize an SMRC AuditLocal 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 ServicesQuarterly 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 PaymentSave Time with eTicket ModuleCertifying 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 InstructionsCollecting From Medicare PatientsMandatory Claims Filing RequirementsEligibility for Medicare: BeneficiariesFraud and AbuseTeaching PhysiciansFederal Regulations: Anti-Kickback and Self-ReferralSignature Requirements on Claims: Medicare PatientsWhat Is Covered Under Medicare Part BAbout MedicareProvider Self Service ApplicationsHealth Professional Shortage AreasRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)MLN Connects for Thursday, May 13, 2021Cognitive Assessment & Care Plan ServicesInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) - October 2021National Coverage Determination (NCD) 210.3 - Screening for Colorectal Cancer (CRC) - Blood-Based Biomarker TestsHealth Care Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021 July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 0240U, 0241U, and 87637Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021Top Time-Saving Tools for Palmetto GBA ProvidersRemittance AdviceNational Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 UpdateNew Editing Established for Federally Qualified Health Center and Rural Health Clinics'What If' and Scenario QuestionsMLN Connects Special Edition - Thursday, July 1, 2021October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementJuly 2021 Update of the Ambulatory Surgical Center [ASC] Payment SystemJuly Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSection 50 in Chapter 30 of Publication (Pub.) 100-04 Manual UpdatesImplement 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 Health Care (CAQH) COREQuarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 27.3, Effective October 1, 2021October 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesMLN Connects Special Edition: Monday, August 2, 2021National Coverage Determination (NCD) RemovalMedicare Coverage for Chiropractic Services: Medical Record Documentation Requirements for Initial and Subsequent VisitsInternet Only Manual Updates to Publication (Pub.) 100-02 to Implement Updates to Policy and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF))New Waived TestsInternet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)Changes to the Laboratory National Coverage Determination [NCD] Edit Software for October 2021Biden-Harris Administration Takes Additional Action to Protect America's Nursing Home Residents from COVID-19Implement 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 Health Care (CAQH) COREMedicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)Annual Clotting Factor Furnishing Fee Update 20222022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentClaims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve RegurgitationOctober 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemInfluenza Vaccine Payment Allowances - Annual Update for 2021-2022 SeasonOctober Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - January 2022Medicare Clarifies Recognition of Interstate License Compacts PathwaysTraining Medicare Patients on Use of Home Glucose Monitors and Related Billing InformationQuarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesChanges to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022Claim Status Category and Claim Status Codes UpdateNational Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell TherapyNew/Modifications to the Place of Service (POS) Codes for Telehealth2022 Medicare Physician Fee Schedule (MPFS) Payment Rates and Participation ProgramInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 2 of 2)MLN Connects for Thursday, November 4, 2021Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationNew Waived Tests2022 Annual Update of Per-Beneficiary Threshold AmountsMedicare Part B CLFS: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System2022 Annual Update to the Therapy Code ListRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateSkilled Nursing Care and Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: ReminderReduced Payment for Physical Therapy and Occupational Therapy Services Furnished in Whole or In Part by a Physical Therapist Assistant or an Occupational Therapy AssistantUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2022Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08Calendar Year 2022 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSummary of Policies in the Calendar Year (CY) 2022 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 ListServices Outside the United StatesFee-For-Time Compensation Arrangements (Formerly Locum Tenens Arrangements)Medicare Diabetes Prevention Program (MDPP) Service Period Change from 2 Years to 1 YearAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 86328Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) Section 240.6January 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemChanges to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022Provider ResponsibilitySkin Substitute CodesCalendar Year (CY) 2022 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 1 of 2)Standard Elements for 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 RequirementsWays to Connect to Palmetto GBACY2022 Telehealth Update Medicare Physician Fee ScheduleHealthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsClinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of SpecimensImportant Information on the Timely Claims Filing RequirementServices and Circumstances That Require Additional DocumentationQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentNational Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2022 UpdateAn Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of CoverageMLN Connects for Thursday, March 3, 2022Internet-Only Manual Updates for Critical Care Evaluation and Management ServicesInternet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician AssistantsMLN Connects for Thursday, March 10, 2022April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleMLN Connects for Thursday, March 17, 2022April 2022 Release Dark Days for the Common Working File (CWF) HostsMLN Connects for Thursday, March 24, 2022April 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateClaims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20-valent Conjugate Vaccine Code 90677MLN Connects Special Edition: Wednesday, March 30, 2022Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemMLN Connects for Thursday, March 31, 2022MLN Connects Special Edition: Thursday, March 31, 2022MLN Connects Special Edition: Monday April 4, 2022MLN Connects Special Edition: Wednesday, April 6, 2022MLN Connects for Thursday April 7, 2022MLN Connects Special Edition: Thursday, April 8, 2022Unsolicited Voluntary RefundsMLN Connects Special Edition: Monday, April 11, 2022MLN Connects for Thursday, April 14, 2021Medicare Provider Alert - Your Responsibility When Using OutsourcersMLN Connects Special Edition for Monday, April 18, 2022Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General UpdatesMLN Connects for Thursday, April 21, 2022New Waived TestsMLN Connects for Thursday, April 28, 2022CWF Editing - National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - July 2022Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter As Certain Colorectal Cancer Screening TestsUpdate of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 - AmbulanceCalendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationNational Coverage Determination (NCD) 210.14 Reconsideration - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)MLN Connects for Thursday, May 5, 2022Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs)-October 2022Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2MLN Connects for Thursday, May 12, 2022MLN Connects for Thursday, May 19, 2022ePass is Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA's Provider Contact CenterIf You've Contacted Us Recently, We Would Love to Hear About Your Experience!eTicket Enables Providers to Save Time with Every CallMLN Connects for Thursday, May 26, 2022

Last Updated: 04/01/2016