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Medicare Advantage Reimbursement Alerts

Daily CMS policy updates, MAC LCD revisions, and coding guidance for Medicare Advantage billing teams. All alerts sourced directly from CMS, MAC contractor sites, and the Federal Register.

Critical alerts active

Total alerts

26

Average signal

65/100

Sources monitored

15+

Latest Medicare Advantage alerts

26

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 Program

Medicare Advantage · Effective 2026-06-01

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 Exchanges

Medicare Advantage

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 Finder

Medicare Advantage · Effective 2025-11-17

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MAC contractor coverage

Medicare Advantage billing is subject to both national CMS policy and regional MAC contractor Local Coverage Determinations (LCDs). CLV Intelligence monitors all MAC contractor sites — Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — for LCD updates affecting Medicare Advantage codes. Coverage criteria vary by contractor jurisdiction.

NoridianCGS AdministratorsFirst CoastNational Government ServicesNovitas SolutionsPalmetto GBAWPS

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Weekly digest of CMS and MAC policy changes for Medicare Advantage billing teams.

Frequently asked questions

What MAC contractors issue LCDs for Medicare Advantage billing?

Medicare Advantage billing is subject to regional Local Coverage Determinations (LCDs) from all seven Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Coverage criteria and medical necessity requirements vary by contractor jurisdiction. CLV Intelligence monitors all MAC contractor sites daily for LCD updates affecting Medicare Advantage codes.

How often does CMS update Medicare Advantage reimbursement policy?

CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting Medicare Advantage reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.

What is a Local Coverage Determination (LCD) and how does it affect Medicare Advantage billing?

A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For Medicare Advantage billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in Medicare Advantage practices.

Reimbursement guides & resources

Plain-language guides to the policy cycles that drive Medicare Advantage reimbursement — the fee schedule, ICD-10, HCPCS, and Local Coverage Determinations.

2027 Fee Schedule Guide

How the CY2027 Medicare Physician Fee Schedule works and what to track.

ICD-10 Change Center

The FY2027 ICD-10-CM update cycle and the October 1 effective date.

HCPCS Quarterly Update

How HCPCS Level II changes every quarter — Jan, Apr, Jul, Oct.

Tracking LCD Changes

How LCDs change across all seven MACs and how to track them.

2027 Prep Checklist

A free, printable checklist for the CY2027 fee schedule cycle.

Other specialties

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