Medicare News

Published 6/1/2016

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.


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Paper Claims Submitted on Outdated CMS-1500 (08-05) Claim Forms Will Be ReturnedSend Medical Documentation to the RRB SMAC: esMD Live for Appeals and Medical Review ADR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 TestingGuidance on Coding and Billing Date of Service on Professional ClaimsCurrent 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 MedicareProhibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersMedically Unlikely Edits (MUE) and Bilateral Surgical ProceduresReminder on Billing Requirements Implemented for non-OPPS ProvidersAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsAccepting Payment from Patients with a Medicare Set-Aside ArrangementNCD 20.4 Implantable Cardiac Defibrillators (ICDs)Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsBilling 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 ModelMedicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentOverview of the Patient Driven Groupings ModelAlpha-Numeric HCPCSPlease Do Not Email Protected Health Information (PHI)Health Professional Shortage Area (HPSA) - Improper Use of the AQ HCPCS Modifier May Reduce Cash FlowReview of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)Beneficiary Signature RequirementsUse 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 Billing2019 Payment Adjustment RemindersMasking of Patient Control Number/Patient Account Number Field on Paper Remittance Advice Began October 1, 2019Important Tax Information - 1099 FormsMedicare Part B 2021 Final Rule: Evaluation and Management Changes - IntroductionQuarterly 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 PaymentAugust 2020 Railroad Medicare NewsFebruary 2021 Railroad Medicare NewsOctober 2020 Railroad Medicare NewsSeptember 2020 Railroad Medicare NewsDecember 2020 Railroad Medicare NewsNovember 2020 Railroad Medicare NewsJanuary 2021 Railroad Medicare NewsMarch 2021 Railroad Medicare NewsMedicare Fee-for-Service (FFS) Response to the 2020 Commonwealth of Puerto Rico EarthquakesCertifying 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 CalculatorMandatory Electronic Submission of Medicare ClaimsProvider Self Service ApplicationsRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021Assisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)May 2021 Railroad Medicare NewsMLN Connects for Thursday, May 13, 2021CMS MLN Fact Sheet: Medical Record Maintenance & Access Requirements Cognitive Assessment & Care Plan ServicesJune 2021 Railroad Medicare NewsJuly 2021 Railroad Medicare NewsMLN Connects Special Edition - Thursday, July 1, 2021August 2021 Railroad Medicare NewsSection 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, 2021Medicare 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 2021September 2021 Railroad Medicare NewsImplement 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 SystemOctober 2021 Railroad Medicare NewsInfluenza 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 2022Quarterly 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 TherapyNovember 2021 Railroad Medicare NewsInternational 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 UpdateDecember 2021 Railroad Medicare NewsSkilled 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) 2022Calendar 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 ListMedicare 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 2022Skin Substitute CodesJanuary 2022 Release Dark Days for the Common Working File (CWF) HostsCalendar 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 RequirementsJanuary 2022 Railroad Medicare NewsCY2022 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 SpecimensFebruary 2022 Railroad Medicare NewsQuarterly 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 WoundsMarch 2022 Railroad Medicare NewsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2022 UpdateInternet-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 AssistantsApril Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleApril 2022 Railroad Medicare NewsApril 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 90677Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemMLN Connects Special Edition: Thursday, April 8, 2022Unsolicited Voluntary RefundsMLN Connects Special Edition: Monday, April 11, 2022MLN Connects for Thursday, April 14, 2021MLN 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, 2022May 2022 Railroad Medicare NewsNew 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 PaymentMLN Connects for Thursday, May 12, 2022MLN Connects for Thursday, May 19, 2022MLN Connects for Thursday, May 26, 2022New/Modifications to the Place of Service (POS) Codes for TelehealthJune 2022 Railroad Medicare NewsAn 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 CoverageUpdate to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) ServicesMLN Connects for Thursday, June 2, 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, June 9, 2022Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023July Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleMLN Connects for Thursday, June 16, 2022MLN Connects Special Edition: Tuesday June 21, 2022Provider Customer Service Center Training and Closure DatesInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs)-October 2022International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021MLN Connects for Thursday, June 23, 2022July 2022 Railroad Medicare NewsRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateJuly 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemChanges to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022MLN Connects for Thursday, June 30, 2022If You've Contacted Us Recently, We Would Love to Hear About Your Experience!