Multi-specialty reimbursement alerts

This new molecular entity from Priovant Therapeutics (NDA220106) received Priority Review and Orphan Drug designation, but the FDA label has not yet published, leaving the drug name, route of administ

Gilead Sciences received FDA approval for a new combination drug (NDA221443) on August 27, 2026, but the FDA label has not yet been published, leaving the route of administration, dosage form, and pha

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

CMS is publishing a Paperwork Reduction Act notice seeking public comment on a proposed information collection activity. This is an administrative notice with no direct changes to billing rates, cover

CMS is publishing a standard Paperwork Reduction Act notice seeking 60-day public comment on a proposed information collection activity. This is an administrative procedural notice with no direct chan

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

This final LCD from WPS (J5/J8) governs coverage criteria for cosmetic versus reconstructive surgery across Iowa, Missouri, Kansas, Nebraska, Indiana, and Michigan, effective August 27, 2026. It estab

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 publishing a routine Paperwork Reduction Act notice inviting 60-day public comment on a proposed information collection activity. This notice does not introduce new billing codes, coverage poli

Takhzyro (lanadelumab-flyo) is a subcutaneously administered plasma kallikrein inhibitor approved for prophylaxis of hereditary angioedema (HAE), billed under Medicare Part B given its subcutaneous ro

PASATRU (garetosmab-grts), approved August 19, 2026 as a new molecular entity via intravenous route, falls under Medicare Part B billing, consistent with provider-administered intravenous drugs reimbu

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

CMS is publishing a routine Paperwork Reduction Act (PRA) notice seeking 60-day public comment on a proposed information collection activity. This is an administrative notice with no direct changes to

CMS is publishing a routine Paperwork Reduction Act notice seeking 60-day public comment on a proposed information collection activity. This notice does not introduce new billing codes, coverage polic

This Type 5 approval represents a new formulation or manufacturer for intravenous sodium bicarbonate solution (NDA218524, Baxter Healthcare Corp), an established drug class with a known intravenous ro

This Type 5 submission represents a new formulation or manufacturer approval for injectable lidocaine hydrochloride (Fresenius Kabi USA, LLC), an established local anesthetic and antiarrhythmic agent

CGS (J15) is finalizing coverage policy for allergy diagnostic testing in Kentucky and Ohio, effective October 4, 2026. As a Final LCD, the comment period has closed, but providers should review cover

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.

Zubsolv (buprenorphine/naloxone) is a sublingual tablet approved for opioid dependence, billing under Medicare Part D as a self-administered oral/sublingual formulation. This Type 5 approval represent

Suboxone (buprenorphine/naloxone) sublingual/buccal film is approved for opioid use disorder and follows a Part D billing pathway as a self-administered oral/mucosal film. Medicare billing occurs thro

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

This final LCD from Noridian (JE/JF) governs coverage criteria for allergy diagnostic testing across 15 western states, effective September 27, 2026. Billing managers should prepare now for updated do

This final LCD from WPS (J5/J8) establishes coverage criteria for allergy diagnostic testing across six Midwestern states, effective September 27, 2026. Providers performing allergy testing must ensur

Palmetto GBA's final LCD L40328 establishes coverage criteria for allergy diagnostic testing under Part A and Part B across seven southeastern states, effective September 27, 2026. Billing teams shoul

This final LCD from Wellpoint Federal governs coverage criteria for allergy diagnostic testing under Medicare Part A and Part B, effective September 27, 2026. It will establish documentation and medic

CMS is publishing a standard Paperwork Reduction Act notice seeking 60-day public comment on a proposed information collection activity. This is an administrative notice with no direct changes to bill

CMS is alerting Qualifying APM Participants (QPs) who are eligible for 2026 APM Incentive Payments that their current billing information is missing, preventing payment disbursement. Affected clinicia

CMS is publishing a standard Paperwork Reduction Act notice requesting 60-day public comment on a proposed information collection activity. This is an administrative notice with no direct changes to b

CMS is proposing the RAPID (Regulatory Alignment for Predictable and Immediate Device) coverage pathway to provide accelerated, expedited national Medicare coverage for new innovative medical technolo

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

CMS is re-establishing a data matching program with the Department of War to verify eligibility for Minimum Essential Coverage (MEC) under the ACA through Department of War health benefit plans. This

CellCept (mycophenolate mofetil) received approval for a new dosage form including an intravenous formulation, which supports a Part B billing pathway for the IV route administered in outpatient or ph

CellCept (mycophenolate mofetil) is an established immunosuppressant approved for prophylaxis of organ transplant rejection, available in both intravenous and oral capsule formulations. The intravenou

GLYCOPHOS (sodium glycerophosphate), approved as an injectable drug under NDA220381, is administered via injection and follows a Part B billing pathway. As a new active ingredient approval, no existin

CMS announces virtual public meetings of the Healthcare Advisory Committee (HAC) for fiscal year 2026-2027. The Committee advises the HHS Secretary and CMS Administrator on healthcare system improveme

Myfortic (mycophenolic acid) is an oral delayed-release tablet approved for transplant rejection prophylaxis, billing under Medicare Part D as a self-administered oral medication. Because it is orally

CellCept (mycophenolate mofetil) received approval for an intravenous dosage form under NDA050759, expanding an existing oral immunosuppressant used primarily in transplant medicine. As an intravenous

CellCept (mycophenolate mofetil hydrochloride) was approved as an injectable dosage form under NDA050758, expanding the existing oral CellCept franchise with an intravenous route of administration. As

Qlonilik (clonidine hydrochloride) is a new oral solution formulation of an established generic drug, approved under NDA221094 as a Type 5 new formulation. As an oral drug, it follows a Part D billing

MYHIBBIN is an oral suspension formulation of mycophenolate mofetil approved under NDA216482, following a Type 5 new formulation pathway. As an oral drug, it falls under Medicare Part D for outpatient

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

CMS is publishing a Paperwork Reduction Act notice seeking public comment on a proposed information collection activity. This is an administrative notice with no direct changes to billing rates, cover

Chlorhexidine gluconate topical solution is a long-established antiseptic skin cleanser with a well-known Part D billing pathway, consistent with its topical, self-administered dosage form. As a gener

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

CMS updates three key DMEPOS lists effective October 28, 2026: the Master List of items potentially subject to face-to-face encounter and written order prior to delivery requirements, the Required Fac

This topical chlorhexidine gluconate foaming hand wash, approved under NDA019422, follows a Part D billing pathway as a topical solution. Given its antimicrobial/antiseptic nature and topical route, i