Specialty × MAC Jurisdiction Intelligence
Medicare AdvantageCMS & MAC AlertsPalmetto GBA · Jurisdictions JJ, JM
Every CMS transmittal, Palmetto GBA LCD revision, Federal Register notice, and OIG alert affecting Medicare Advantage billing teams in Georgia, North Carolina, South Carolina, Tennessee, Virginia, West Virginia. Signal-scored and updated daily.
Active alerts
12
Critical / High
8
MAC jurisdiction
JJ, JM
Highest-risk CPT
CPT 99214
Recent Medicare Advantage alerts under Palmetto GBA
8 of the 12 most recent Medicare Advantage 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.
- Federal Register Notice: Medicare Program; Approved Renewal of Deeming Authority of the National Committee for Quality Assurance (NCQA) for Medicare Advantage Health Maintenance Organizations and Preferred Provider OrganizationsJul 25, 2026
- Federal Register Notice: Agency Information Collection Activities: Submission for OMB Review; Comment RequestJun 5, 2026
- Federal Register Notice: Agency Information Collection Activities: Submission for OMB Review; Comment RequestJun 5, 2026
- Federal Register Notice: Medicare Program; Request for Information on Medicare Advantage DataJun 5, 2026
- Federal Register Final Rule: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE)-Finalization of Format Provider Directories for Medicare Plan FinderJun 5, 2026
- Federal Register Final Rule: Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021Jun 5, 2026
- Federal Register Proposed Rule: Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated ExchangesJun 5, 2026
- Federal Register Final Rule: Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan ProgramJun 5, 2026
- Federal Register Proposed Rule: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health ProgramJun 5, 2026
- Federal Register Proposed Rule: Guarding U.S. Medicare Against Rising Drug Costs (GUARD) ModelJun 5, 2026
- Federal Register Proposed Rule: Global Benchmark for Efficient Drug Pricing (GLOBE) ModelJun 5, 2026
- Federal Register Proposed Rule: Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan ProgramJun 5, 2026
Signal intelligence — Medicare Advantage × 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 medicare advantage LCD revision, CMS transmittal, and Federal Register notice affecting these states is signal-scored and surfaced here daily.
View all 12 active alerts for Medicare Advantage 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 Medicare Advantage 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 Medicare Advantage under Palmetto GBA MAC?
- According to CLV Intelligence data, updated July 25, 2026, there are currently 12 active CMS and MAC reimbursement policy alerts for Medicare Advantage under Palmetto GBA (Jurisdictions JJ, JM). Of these, 8 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 Medicare Advantage CPT codes under Palmetto GBA?
- According to CLV Intelligence data, 12 active reimbursement and policy alerts currently affect Medicare Advantage CPT codes monitored under Palmetto GBA (Jurisdictions JJ, JM). 8 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 Medicare Advantage 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 Medicare Advantage billing teams.
- Which MAC jurisdiction covers Medicare Advantage 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 Medicare Advantage 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 Medicare Advantage alerts as of July 25, 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 Medicare Advantage?
- According to CLV Intelligence data, CPT 99214 (Office visit, established patient, moderate complexity) is currently flagged as a high-signal procedure code within the Medicare Advantage 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. Medicare Advantage 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.