FDA Approval: EXDENSUR (DEPEMOKIMAB) — Type 1 - New Molecular Entity
Rheumatology · Effective 2025-12-16
Specialty intelligence
Rheumatology Reimbursement Alerts
Daily CMS policy updates, MAC LCD revisions, and coding guidance for Rheumatology billing teams. All alerts sourced directly from CMS, MAC contractor sites, and the Federal Register.
Total alerts
5
Average signal
66/100
Sources monitored
15+
Latest Rheumatology alerts
5LCD L39427: MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis — CGS
Rheumatology · Effective 2025-08-07
LCD L39469: MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis — Noridian
Rheumatology · Effective 2025-08-07
+ 2 more Rheumatology alerts
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MAC contractor coverage
Rheumatology 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 Rheumatology 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 Rheumatology billing teams.
Frequently asked questions
What MAC contractors issue LCDs for Rheumatology billing?
Rheumatology 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 Rheumatology codes.
How often does CMS update Rheumatology 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 Rheumatology 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 Rheumatology 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 Rheumatology 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 Rheumatology practices.
Reimbursement guides & resources
Plain-language guides to the policy cycles that drive Rheumatology 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.
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