Specialty × MAC Jurisdiction Intelligence
ESRDCMS & MAC AlertsPalmetto GBA · Jurisdictions JJ, JM
Every CMS transmittal, Palmetto GBA LCD revision, Federal Register notice, and OIG alert affecting ESRD billing teams in Georgia, North Carolina, South Carolina, Tennessee, Virginia, West Virginia. Signal-scored and updated daily.
Active alerts
12
Critical / High
9
MAC jurisdiction
JJ, JM
Highest-risk CPT
CPT 99214
Recent ESRD alerts under Palmetto GBA
9 of the 12 most recent ESRD reimbursement alerts are Critical/High-severity for Palmetto GBA (Jurisdictions JJ, JM) billing teams. Each links to the source CMS/MAC document with the codes to review and the action to take.
- CMS Transmittal R246SOMA: Revisions to the State Operations Manual (SOM) Appendix H, End-Stage Renal Disease (ESRD)…Aug 18, 2026
- LCD L37475: Frequency of Hemodialysis — Wellpoint FederalNational Government Services · Jul 23, 2026
- CMS Transmittal R13822CP: Quarterly Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)Jun 10, 2026
- Federal Register Final Rule: Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury DialysisJun 5, 2026
- Federal Register Notice: Medicare and Medicaid Programs: Application From the Accreditation Commission for Health Care, Inc. for Continued Approval of Its End-Stage Renal Disease (ESRD) Accreditation ProgramJun 5, 2026
- Federal Register Final Rule: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices ModelJun 5, 2026
- Federal Register Proposed Rule: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices ModelJun 5, 2026
- Federal Register Final Rule: Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) ModelJun 5, 2026
- Federal Register Final Rule: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, Conditions for Coverage for End-Stage Renal Disease Facilities, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices ModelJun 5, 2026
- Federal Register Proposed Rule: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, Conditions for Coverage for End-Stage Renal Disease Facilities, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices ModelJun 5, 2026
- Federal Register Proposed Rule: Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) ModelJun 5, 2026
- Federal Register Final Rule: Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices ModelJun 5, 2026
Signal intelligence — ESRD × Palmetto GBA
Highest-risk CPT code
CPT 99214
Office visit, established patient, moderate complexity
View full CPT alert profilePalmetto GBA jurisdiction
JJ, JM
Covers Georgia, North Carolina, South Carolina, Tennessee, Virginia, West Virginia. Every esrd LCD revision, CMS transmittal, and Federal Register notice affecting these states is signal-scored and surfaced here daily.
View all 12 active alerts for ESRD under Palmetto GBA
Full alert text, action recommendations, effective date deadlines, MAC LCD links, and signal score rationale — updated daily.
About Palmetto GBA (Jurisdictions JJ, JM)
Palmetto GBA is the Medicare Administrative Contractor responsible for processing Medicare Part A and Part B claims in Jurisdictions JJ, JM, covering Georgia, North Carolina, South Carolina, Tennessee, Virginia, West Virginia.Palmetto GBA issues Local Coverage Determinations (LCDs) that define coverage criteria, ICD-10-CM diagnosis code requirements, and CPT billing guidelines for ESRD procedures within its jurisdiction. CLV Intelligence monitors Palmetto GBA's LCD publication feed, provider bulletin archives, and CMS contractor-specific transmittals daily.
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Frequently asked
- What are the recent CMS updates for ESRD under Palmetto GBA MAC?
- According to CLV Intelligence data, updated August 18, 2026, there are currently 12 active CMS and MAC reimbursement policy alerts for ESRD under Palmetto GBA (Jurisdictions JJ, JM). Of these, 9 are classified Critical or High priority based on signal scoring of source authority, effective-date urgency, and document type. Alerts originate from Palmetto GBA Local Coverage Determinations (LCDs), CMS transmittals, Federal Register proposed and final rules, and OIG compliance publications. CLV Intelligence monitors all Palmetto GBA publications daily and assigns a signal score (0–100) to surface the changes most likely to affect coding accuracy and reimbursement.
- How many active audit alerts exist for ESRD CPT codes under Palmetto GBA?
- According to CLV Intelligence data, 12 active reimbursement and policy alerts currently affect ESRD CPT codes monitored under Palmetto GBA (Jurisdictions JJ, JM). 9 of these alerts carry a Critical or High signal score, indicating elevated compliance risk or near-term effective dates requiring timely coding review. The highest-risk CPT code currently flagged in the ESRD alert set is CPT 99214 (Office visit, established patient, moderate complexity), which appears in Palmetto GBA LCD and CMS billing guidance revisions. CLV Intelligence cross-references each alert against the HCPCS and CPT code sets to surface procedure-level exposure for ESRD billing teams.
- Which MAC jurisdiction covers ESRD billing for practices in the Palmetto GBA region?
- Palmetto GBA administers Medicare Part A and Part B claims for practices in Jurisdictions JJ, JM. For ESRD providers, Palmetto GBA issues Local Coverage Determinations (LCDs) that define coverage criteria, billing requirements, ICD-10-CM diagnosis code ranges, and CPT procedure code guidelines applicable to Medicare claims in its jurisdiction. According to CLV Intelligence data, Palmetto GBA monitors 12 open ESRD alerts as of August 18, 2026. Practices in the Palmetto GBA jurisdiction should monitor LCD revisions at Palmetto GBA's provider portal and through aggregated daily alerting services such as CLV Intelligence.
- Is CPT 99214 currently under CMS or MAC review for ESRD?
- According to CLV Intelligence data, CPT 99214 (Office visit, established patient, moderate complexity) is currently flagged as a high-signal procedure code within the ESRD alert set monitored under Palmetto GBA (Jurisdictions JJ, JM). CMS and MAC contractors regularly review high-volume procedure codes for coverage criteria changes, NCCI edit revisions, medical necessity documentation requirements, and fee schedule adjustments. CLV Intelligence assigns CPT 99214 an elevated signal score based on the volume and recency of policy documents referencing this code. ESRD coding teams should review the latest Palmetto GBA LCD and CMS transmittals affecting CPT 99214 before claim submission to avoid denials or post-payment audits.