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


Paper Claims Submitted on Outdated CMS-1500 (08-05) Claim Forms Will Be ReturnedSend Medical Documentation to the RRB SMAC: esMD Live for Appeals and Medical Review ADR ResponsesBankruptcyMedicare Fee-for-Service (FFS) Response to the 2017 California WildfiresNational Correct Coding Initiative (NCCI) ToolHelp Us to Help You: Have Your Provider and Patient Information Ready When You Call Customer ServiceMedicare Fee-for-Service (FFS) Response to the 2017 Southern California WildfiresProper 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 ClaimsUpdating Calendar Year (CY) 2021 Medicare Diabetes Prevention Program (MDPP) Payment RatesBilling for Home Infusion Therapy Services On or After January 1, 2021April 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemCurrent Medicare Coverage of Diabetes SuppliesFoot Care Coverage GuidelinesPre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention ProgramAdvanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 WebsiteIncorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any TypeInternet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19Palmetto GBA B Notice or 1099 Request FormProper Use of Modifier 59Next Generation Accountable Care Organization - ImplementationSection 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicareAnnual Clotting Factor Furnishing Fee Update 2021Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramClaim Status Category and Claim Status Codes UpdatesCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021Medically Unlikely Edits (MUE) and Bilateral Surgical ProceduresJuly Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule2021 Annual Update of Per-Beneficiary Threshold AmountsReminder on Billing Requirements Implemented for non-OPPS ProvidersMLN Connects for Thursday, February 18, 2021Ambulance Inflation Factor (AIF) for Calendar Year (CY) 2021 and Productivity AdjustmentAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsMLN Connects for Thursday, January 21, 2021NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR)Accepting Payment from Patients with a Medicare Set-Aside ArrangementNational Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)MLN Connects Special Edition - Monday, December 14, 2020NCD 20.4 Implantable Cardiac Defibrillators (ICDs)2021 Annual Update to the Therapy Code List2021 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) UpdateMedicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementValue-Based Insurance Design (VBID) Model - Implementation of the Hospice Benefit ComponentQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 UpdateFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsMedicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemCY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleJuly 2020 Update of the Ambulatory Surgical Center (ASC) Payment System2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsMLN Connects for Thursday, January 7, 2021MLN Connects for Thursday, December 17, 2020Claim Status Category and Claim Status Codes UpdateFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsMLN Connects for Thursday, February 11, 2021Billing for Services when Medicare is a Secondary PayerReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesPayments and Payment Adjustments under the Patient-Driven Groupings ModelCalendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable ChargeNational Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)Update to the Medicare Claims Processing ManualMLN Connects Special Edition - Friday, December 18, 2020: COVID-19: Add-on Payment for New Treatments.Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentOverview of the Patient Driven Groupings ModelSummary 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 ListStandard 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 RequirementsAlpha-Numeric HCPCSPlease Do Not Email Protected Health Information (PHI)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 ServicesHealth Professional Shortage Area (HPSA) - Improper Use of the AQ HCPCS Modifier May Reduce Cash FlowNational Coverage Determination (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM)Telehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - ImplementationReview of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)October 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemClaim Status Category and Claim Status Codes UpdateNational Coverage Determination (NCD 90.2): Next Generation Sequencing (NGS) for Medicare Beneficiaries with Germline (Inherited) CancerManual 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 SectionQuarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 UpdateMLN Connects Special Edition - Wednesday, December 9, 2020Beneficiary Signature RequirementsOctober Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleProvider Compliance Tips for Polysomnography (Sleep Studies) - RevisedUse of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)A Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019Educational Resources to Assist Chiropractors with Medicare BillingAdd 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 HCPCSQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 UpdateMLN Connects for Thursday, March 4, 2021Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2020 UpdateApril Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleInfluenza Vaccine Payment Allowances - Annual Update for 2020-2021 SeasonTherapy Codes Update2019 Payment Adjustment RemindersMasking of Patient Control Number/Patient Account Number Field on Paper Remittance Advice Began October 1, 2019Fraud Alert: Genetic Testing ScamImportant Tax Information - 1099 FormsHCPCS Code G2211 is a Bundled Service and Not Separately PaidMedicare Part B 2021 Final Rule: Evaluation and Management Changes - IntroductionMLN Connects for Thursday, December 10, 2020Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 UpdateRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print UpdateApril Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentMay 2019 Railroad Medicare NewsApril 2019 Railroad Medicare NewsAugust 2020 Railroad Medicare NewsDecember 2019 Railroad Medicare NewsNovember 2019 Railroad Medicare NewsOctober 2019 Railroad Medicare NewsJune 2020 Railroad Medicare NewsFebruary 2021 Railroad Medicare NewsMarch 2020 Railroad Medicare NewsMay 2020 Railroad Medicare NewsOctober 2020 Railroad Medicare NewsFebruary 2020 Railroad Medicare NewsApril 2020 Railroad Medicare NewsSeptember 2020 Railroad Medicare NewsJuly 2020 Railroad Medicare NewsDecember 2020 Railroad Medicare NewsJanuary 2020 Railroad Medicare NewsJuly 2019 Railroad Medicare NewsJune 2019 Railroad Medicare NewsNovember 2020 Railroad Medicare NewsAugust 2019 Railroad Medicare NewsSeptember 2019 Railroad Medicare NewsJanuary 2021 Railroad Medicare NewsMarch 2021 Railroad Medicare NewsAddition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final RulesMedicare Fee-for-Service (FFS) Response to the 2020 Commonwealth of Puerto Rico EarthquakesHealthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsMLN Connects for Wednesday, December 23, 2020MLN Connects Special Edition - Tuesday, December 22, 2020Certifying Patients for the Medicare Home Health BenefitCMS Open Payments Data WebsiteNew Medicare Beneficiary Identifier (MBI) Get It, Use ItApril 2021 Railroad Medicare NewsClaims Requiring Fax DocumentationThe Stage 1 Meaningful Use Attestation CalculatorUpdated Billing Requirements for Home Infusion Therapy (HIT) Services on or After January 1, 2021Mandatory Electronic Submission of Medicare ClaimsProvider Self Service ApplicationsUpdate to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B ServicesClaims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementApril 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemAssisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)Common Working File (CWF) Edits for Medicare Telehealth Services and Manual UpdateJanuary 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 2021May 2021 Railroad Medicare NewsSpecial Provisions for Radiology Additional Documentation RequestsNew Waived TestsAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 876362021 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction ListMLN Connects for Thursday, May 13, 2021Addition of the Shared System CWF to the Business Requirements for the Healthcare Common Procedure Coding System (HCPCS) Codes U0002QW and 87635QW Mentioned in Change Request 11765Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update CMS MLN Fact Sheet: Medical Record Maintenance & Access Requirements Cognitive Assessment & Care Plan ServicesJune 2021 Railroad Medicare NewsInternational 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 TestsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021 Health Care Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsJuly 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 2021National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 UpdateJuly 2021 Railroad Medicare NewsJuly 2021 Release Dark Days for the Common Working File (CWF) Hosts MLN Connects Special Edition - Monday, June 28, 2021MLN Connects for Thursday, July 1, 2021MLN 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 ScheduleMLN Connects for Thursday, July 8, 2021MLN Connects Special Edition - Tuesday, July 13, 2021MLN Connects for Thursday, July 15, 2021MLN Connects Special Edition: Monday, July 19, 2021August 2021 Railroad Medicare NewsMLN Connects for Thursday, July 22, 2021Section 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 FilesNational Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell TherapyMLN Connects for Thursday, July 29, 2021MLN Connects Special Edition: Thursday, July 29, 2021MLN Connects Special Edition: Monday, August 2, 2021MLN Connects for Thursday, August 5, 2021National Coverage Determination (NCD) RemovalClinical Laboratory Fee Schedule: Medicare Travel Allowance Fees for Collection of SpecimensMedicare 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 TestsModifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationInternet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)MLN Connects for Thursday, August 12, 2021MLN Connects Special Edition: Friday, August 13, 2021Changes to the Laboratory National Coverage Determination [NCD] Edit Software for October 2021MLN Connects Special Edition: Monday, August 16, 2021MLN Connects for Thursday, August 19, 2021MLN Connects Special Edition for Tuesday, August 24, 2021September 2021 Railroad Medicare NewsInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - January 2022MLN Connects for Thursday, August 26, 2021MLN Connects for Thursday, September 2, 2021Implement 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)MLN Connects for Thursday, September 9, 2021MLN Connects Special Edition for Thursday, September 9, 2021Annual 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 PaymentInfluenza Vaccine Payment Allowances - Annual Update for 2021-2022 SeasonIf You've Contacted Us Recently, We Would Love to Hear About Your Experience!Claims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve RegurgitationMLN Connects for Thursday, September 16, 2021National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsOctober 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemMLN Connects Special Edition for Monday, September 20, 2021Provider Customer Service Center Training and Closure DatesMLN Connects for Thursday, September 23, 2021October 2021 Railroad Medicare NewsMLN Connects Special Edition for Friday, September 24, 2021