R13 reimbursement alerts

This transmittal updates Chapters 3, 4, and 5 of Publication 100-15, which governs Medicaid program guidance. Billing teams should review the specific chapter amendments for any changes to eligibility

This transmittal implements the October 2026 quarterly HCPCS code update effective October 5, 2026, with changes to procedure codes used in Medicare claims processing. Billing teams must update their

This transmittal addresses reporting requirements for face-to-face (F2F) encounters conducted by a hospice physician or hospice nurse practitioner, effective January 4, 2027. Billing teams must update

This one-time notification addresses HIPAA Electronic Data Interchange (EDI) requirements under CR 14429, effective October 5, 2026. Billing teams should review their EDI transaction systems and tradi

Transmittal R13904CP (CR 14574) updates Chapter 1 of the Medicare Claims Processing Manual (Pub. 100-04), effective for implementation on September 28, 2026. The subject line is truncated and the full

This transmittal provides instructions for downloading updated HCPCS files effective January 4, 2027. Billing teams should prepare to download and implement the new HCPCS code files when released. Sys

CMS is updating the annual clotting factor furnishing fee for 2027, effective January 4, 2027. Billing teams must update their fee schedules to reflect the new furnishing fee amounts for clotting fact

This transmittal implements the quarterly October 2026 update to the Medicare Physician Fee Schedule Database (MPFSDB), effective October 5, 2026. Billing teams should anticipate changes to relative v

CMS is updating NCD 210.3 for colorectal cancer screening via non-invasive biomarker tests, with claims processing changes effective January 4, 2027. Billing teams must review and update their coding

CMS is updating NCD 210.3 to revise coverage policy for non-invasive biomarker-based colorectal cancer screening tests under Medicare. Billing teams should prepare for updated coverage criteria, eligi

This transmittal implements the October 2026 quarterly update to the Clinical Laboratory Fee Schedule (CLFS), effective October 5, 2026. Billing teams should anticipate updated payment rates and poten

This transmittal implements the October 2026 quarterly HCPCS code update effective October 5, 2026, affecting claims processing systems. Billing teams must update their chargemasters, claim edits, and

This one-time notification (CR 14553) targets A/B MACs Part A and the Fiscal Intermediary Shared System (FISS), with an implementation date of January 4, 2027. The transmittal subject is truncated, so

This one-time notification (CR 14454) directs modifications to the Fiscal Intermediary Shared System (FISS) and its Expert Claims Processing System (ECPS), with implementation set for January 4, 2027.

This transmittal updates Hospice payment rates, the hospice cap amount, wage index values, and the Hospice Pricer effective for the new fiscal year beginning October 1, 2026. Billing teams must ensure

This CMS transmittal (CR 14464) implements ICD-10 and other coding revisions effective October 5, 2026, aligning with the annual ICD-10 code set update cycle. Billing teams must update their charge ma

CMS is issuing ICD-10 and other coding revisions effective January 4, 2027, via CR 14570. Billing teams should prepare for updated diagnosis code sets and related coding changes that will impact claim

CMS is implementing ICD-10 and other coding revisions effective January 4, 2027, via CR 14570. Billing teams must update their code sets and claim submission processes to incorporate the new ICD-10 co

CMS is issuing ICD-10 and other coding revisions effective January 4, 2027, requiring billing teams to update their code sets and charge masters ahead of the implementation date. This one-time notific

This transmittal (CR 14457) extends the default recoupment date for Part A cost report overpayments and revises related processes, effective January 4, 2027. Billing teams at Part A providers (hospita

This transmittal implements the annual IRF PPS update effective for services on or after October 1, 2026 (FY2027). Billing teams must ensure claims processing systems are updated by October 5, 2026 to

This transmittal updates the Medicare Part A SNF PPS Web Pricer tool, effective October 5, 2026, under CR 14545. Billing teams should prepare for updated SNF prospective payment rates to be reflected

This transmittal updates Hospice payment rates, the hospice aggregate cap amount, wage index values, and the Hospice Pricer effective for the new fiscal year beginning October 1, 2026. Billing teams m

This transmittal implements FY 2027 MS-DRG updates effective October 5, 2026, impacting inpatient hospital claims processing. Billing teams must update their grouper software and charge description ma

This transmittal revises Chapter 12 of the CERT Program guidelines and updates Exhibit 46, effective August 28, 2026. Billing teams should review the updated CERT documentation requirements to ensure

This transmittal updates IOM Publication 100-06 Chapter 8, which governs contractor financial management and cost reporting procedures. Billing teams should review the updated Chapter 8 guidance to en

This transmittal updates Medicare Benefit Policy Manual Chapter 15, Section 110.8 regarding Durable Medical Equipment (DME) policy. Billing teams should review the updated DME coverage criteria and do

CMS is requiring that 'Reason for Denial' values from Prior Authorization data be transmitted to the Integrated Data Repository (IDR) effective October 5, 2026. This is a systems/data reporting change

This one-time notification (CR 14529) directs modification of application logic in the Medicare Carrier System (MCS) to conditionally retain certain Medicare data. The implementation date is January 4

This transmittal (CR 14549) updates Chapters 4 and Exhibit 16 of CMS Publication 100-08, the Medicare Program Integrity Manual. The changes affect program integrity and medical review policies, which

This one-time notification (CR 14538) implements VMS Application Programming Interfaces (APIs) to support Durable Medical Equipment processes, effective October 5, 2026. Billing teams should prepare f

CMS is expanding the Supplemental Security Income (SSI) ratio data used in the Inpatient Provider Specific File, with implementation effective July 4, 2027. This change affects how SSI ratios are calc

CMS is updating the Medicare payment allowances for influenza vaccines for the 2026-2027 flu season, effective August 17, 2026. Billing teams must update their charge masters and fee schedules to refl

CMS is updating the Medicare interest rate applicable to overpayments and underpayments for the 4th quarter period, effective July 21, 2026. This rate change affects how interest is calculated on outs

This transmittal (CR 14525) addresses file conversions related to the Spanish translation of the Healthcare Common Procedure Coding System (HCPCS). Billing teams should prepare for system-level file f

This transmittal (CR 14495) updates claims processing instructions for reporting face-to-face (F2F) encounter requirements conducted by a hospice physician or hospice nurse practitioner. Billing teams

This transmittal updates the Electronic Correspondence Referral System (ECRS) to prevent creation of erroneous records when submitting Prescription Drug Inquiries (PDIs) under Medicare Secondary Payer

This one-time notification addresses HIPAA Electronic Data Interchange (EDI) requirements under CR 14429, effective October 5, 2026. Billing teams should review their EDI transaction sets and trading

CMS is implementing the FY 2027 annual update to the Medicare Code Editor (MCE) and ICD-10 code sets, effective October 5, 2026. Billing teams must update their claim editing systems and encoders to r

This transmittal implements a quarterly HCPCS code update specifically for Home Health claims processing, effective October 5, 2026. Billing teams must update their code sets to reflect the new, revis

This transmittal implements a quarterly update to the Home Health (HH) Grouper, effective October 5, 2026. Billing teams should prepare for potential changes to HIPPS code assignments and case-mix gro

This transmittal (CR 14220) updates Chapter 10 of the CMS Program Integrity Manual to incorporate recent provider enrollment regulatory changes, effective August 7, 2026. Billing teams should review u

This transmittal implements CR 14262, directing systems to send Transplant Program Hospital Type and new organ type data to Fiscal Intermediaries/MACs. Billing teams should verify that transplant prog

CMS is updating the Laboratory NCD Edit Software effective October 5, 2026, to reflect changes in National Coverage Determinations for lab services. Billing teams must review updated NCD edits in thei

This transmittal implements the July 2026 quarterly update to the Clinical Laboratory Fee Schedule (CLFS), effective July 6, 2026. Billing teams must update their lab fee schedule tables to reflect th

This transmittal implements editing for Programs of All-Inclusive Care for the Elderly (PACE) inpatient claims, effective April 6, 2026. Billing teams should review PACE inpatient claim submissions to

CMS is releasing the July 2026 Integrated Outpatient Code Editor (I/OCE) Specifications Version 27.2, effective July 6, 2026. This update modifies the logic used to edit and process outpatient claims,

This transmittal implements the July 2026 quarterly update for DMEPOS billing, effective July 6, 2026. Billing teams should review updated fee schedules, coverage criteria, and any new or revised HCPC

CMS is implementing the July 2026 quarterly update to the Medicare Physician Fee Schedule Database (MPFSDB), effective July 6, 2026. This update likely includes revised RVUs, payment rates, and coding

This transmittal addresses file conversions related to the Spanish translation of the Healthcare Common Procedure Coding System (HCPCS). Billing teams should prepare for system file updates effective