Outpatient reimbursement alerts

This active final LCD from Wellpoint Federal governs coverage criteria for reduction mammaplasty under both Part A and Part B, effective April 1, 2026. It establishes the medical necessity standards a

This active final LCD from Wellpoint Federal establishes coverage criteria for Posterior Tibial Nerve Stimulation (PTNS) for voiding dysfunction under Medicare Parts A and B, effective April 1, 2026.

This active final LCD from Wellpoint Federal governs coverage criteria for outpatient physical and occupational therapy services under Medicare Part A and Part B, effective April 1, 2026. It establish

This active final LCD (L33576) from Wellpoint Federal governs coverage criteria for urodynamic testing under both Part A and Part B, effective April 1, 2026. It establishes documentation and medical n

This active final LCD from Wellpoint Federal governs coverage criteria for routine foot care and nail debridement services under Medicare Part A and Part B, effective April 1, 2026. It establishes the

This final LCD (L33575) from Wellpoint Federal governs coverage criteria for treatment of varicose veins of the lower extremity, effective April 1, 2026. It applies to both Part A and Part B claims an

CMS is approving The Joint Commission for continued recognition as a national accrediting organization for home health agencies (HHAs) participating in Medicare and Medicaid. This administrative decis

CMS announces a virtual public meeting of the Advisory Panel on Hospital Outpatient Payment scheduled for August 24, 2026. The Panel advises on the clinical integrity of Ambulatory Payment Classificat

CMS proposes updates to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems for CY2027, including revised payment rates and quality reporting

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,

The July 2026 Update of the Ambulatory Surgical Center (ASC) Payment System includes changes that billing teams must implement by July 6, 2026. Specifically, review any billing related to ASC services

The July 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS) affects billing practices by updating payment rates and possibly introducing new service codes. Billing teams must rev

The updates to HCPCS codes pertaining to face-to-face encounters requires billing team review. This change is crucial for ensuring that providers adhere to the u

This correction to the CY 2026 OPPS/ASC final rule addresses technical errors, which may affect the accuracy of reimbursement amounts for outpatient services and surgical centers. Accurate coding and

The upcoming Advisory Panel meeting may lead to adjustments in payment classifications for outpatient services, impacting reimbursement rates under the Medicare Hospital Outpatient Prospective Payment

The recent correction to the Hospital Outpatient Prospective Payment System reaffirms reimbursement protocols that impact outpatient services and ambulatory surgical centers. Stakeholders must be awar

The announcement of the monthly actuarial rates and premium rates for Medicare Part B will significantly impact billing and reimbursement practices for healthcare providers starting January 1, 2025. T

The upcoming Advisory Panel meeting will influence the clinical integrity of payment classifications vital to the Hospital Outpatient Prospective Payment System (OPPS). Adjustments and recommendations

The proposed rule regarding the 340B-acquired drug payment policy could significantly impact reimbursement rates for outpatient services related to such drugs. Stakeholders are encouraged to provide c

The new Medicare program rule could significantly impact reimbursement rates for hospital outpatient departments and ambulatory surgical centers. With proposed changes to quality reporting and service

The recent updates in the Hospital Outpatient Prospective Payment System emphasize new payment policies and conditions of participation for services offered by rural emergency hospitals. This will imp

The proposed changes to the Hospital Outpatient Prospective Payment System could significantly affect reimbursement strategies for outpatient services, particularly in rural areas. Additionally, updat

The Advisory Panel on Hospital Outpatient Payment meeting will influence Medicare's OPPS and associated weights for Ambulatory Payment Classification groups. Changes in these classifications can signi

The proposed rule addresses adjustments to the 340B-acquired drug payment policy, which may significantly impact reimbursement for hospital outpatient services. This change could lead to improved fina

The correction of technical errors in the Hospital Outpatient and Ambulatory Surgical Center payment systems ensures clarity in billing and reimbursement practices, potentially enhancing compliance an

The recent correction in the Hospital Outpatient Payment System may affect reimbursement rates for outpatient services and intensive outpatient programs. It is essential for providers to stay updated

The proposed rule aims to boost the procurement of American-made PPE and essential medicines in Medicare participating hospitals, potentially leading to reimbursement adjustments that reflect the incr

The upcoming changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center payment systems for 2026 may significantly affect reimbursement rates for various outpa

The proposed rule aims to revise the OPPS and ASC payment systems for 2026, which will potentially affect reimbursement rates for hospital outpatient services. Additionally, updates to quality reporti

The solicitation for additional participants in the Rural Community Hospital Demonstration Program may affect reimbursement structures for facilities participating in rural healthcare services. Enhanc

The upcoming changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system are poised to affect reimbursement rates significantly. P

The proposed rule seeks to update the OPPS and ASC payment systems for 2025, which may impact hospital reimbursement rates based on quality metrics. Adjustments in payment rates and reporting requirem

The new Medicaid DSH rule provides clarity for States and hospitals regarding the calculation of the hospital-specific limit on DSH payments. This improvement in administrative efficiency may impact r

The CMS's information collection activities could affect billing and reimbursement processes by ensuring that necessary data is gathered to maintain compliance with regulations. Comments from the publ

The recent updates to the OPPS and ASC payment systems will impact reimbursement rates for outpatient services in 2024. Providers should be prepared for adjustments in payment amounts, particularly fo

The final rule implements adjustments to Medicare payment rates for drugs purchased under the 340B Program, directly impacting reimbursement for outpatient hospital services from 2018 to 2022. This ch

The proposed changes to the OPPS and ASC payment systems are expected to have a significant impact on reimbursement rates for hospital outpatient services and ambulatory surgical centers, potentially

The proposed rule addresses the 340B drug payment policy modifications, which could influence reimbursement strategies for hospitals under the Hospital Outpatient Prospective Payment System (OPPS). Th

The new policy mandates the inclusion of Medicare Part C days in calculating a hospital's disproportionate patient percentage. This change could potentially influence reimbursement rates for hospitals

The proposed rule aims to modify how days associated with individuals benefiting from section 1115 demonstrations are counted in the Medicaid fraction for DSH payments. This change could potentially i

The introduction of new immunization LCD by WPS may require updates to billing practices to ensure compliance and maximize reimbursement. Providers must review the covered immunizations and adjust the

The introduction of the ProMark® Risk Score is expected to impact billing practices by establishing new criteria for reimbursement starting January 1, 2026. Providers must ensure compliance with the u

The implementation of the new LCD for Immune Globulins may affect the billing process by introducing changes in coverage criteria and reimbursement rates specific to these treatments. Providers will n

The implementation of the wound care LCD by Novitas may require providers to ensure compliance with new coverage criteria, which can impact billing processes. This may lead to adjustments in documenta

The final LCD L34209 outlines the coverage for the treatment of varicose veins in the lower extremities, affecting various states including CA, NV, and WA. Providers should review this document carefu

This LCD covers molecular testing for risk stratification of thyroid nodules, which helps in determining the likelihood of malignancy in patients. The billing implications suggest that tests falling u

This LCD covers outpatient psychiatry and psychology services, detailing the criteria for coverage of these services under Medicare. It affects billing practices for healthcare providers delivering me

This Local Coverage Determination (LCD) addresses billing for outpatient physical and occupational therapy services. It affects providers offering these therapy services under Medicare Part A and Part

This document corrects technical errors in the final rule with comment period that appeared in the November 25, 2025 issue of the Federal Register titled "Medic