Medicare News

Published 04/01/2016

Medicare News includes information for health care professionals about Medicare programs, policies and initiatives. Use these resources to stay up-to-date about current and planned Medicare changes.

Palmetto GBA maintains links to recently released and revised Centers of Medicare & Medicaid Services (CMS) MLN® articles. All MLN Matters articles will continue to be available on the CMS MLN Matters website. MLN Connects® will contain Medicare related messages from CMS. These messages ensure planned, coordinated messages are delivered timely about Medicare related topics.


December 2020 Medicare AdvisoryNovember 2020 Medicare AdvisorySeptember 2020 Medicare AdvisoryGuidance on Coding and Billing Date of Service on Professional ClaimsProvider Enrollment - Unlicensed ResidentsProper Coding for Specimen Validity Testing Billed in Combination with Drug TestingOctober 2020 Medicare AdvisoryInternet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention ProgramCurrent Medicare Coverage of Diabetes SuppliesFoot Care Coverage GuidelinesIncorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any TypeAdvanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 WebsiteProper Use of Modifier 59How often does CMS update the Medicare Revalidation List due date information?How to Use the Medicare Coverage DatabaseCMS Provider Minute Videos for Part A and Part B Providers and DMEPOS SuppliersProhibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramSection 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicarePalmetto GBA B Notice or 1099 Request FormNext Generation Accountable Care Organization - ImplementationBeneficiary Signature RequirementsHealth Professional Shortage Area (HPSA) - Improper Use of the AQ HCPCS Modifier May Reduce Cash FlowMedicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentOverview of the Patient Driven Groupings ModelReview of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)NCD 20.4 Implantable Cardiac Defibrillators (ICDs)Billing for Services when Medicare is a Secondary PayerMedicare Advantage Plan Directory (CMS website)Medicare Advantage (MA) Plans Adherence to Local and National Coverage Determination InquiriesUse of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementA Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019Submit Medical Record Documentation via esMDAlpha-Numeric HCPCSMLN Matters Article 12093 Outlines Use of CLIA Waiver Modifier for Two CodesFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsAccepting Payment from Patients with a Medicare Set-Aside ArrangementReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesIdentify a Medicare Advantage PlanAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsPayments and Payment Adjustments under the Patient-Driven Groupings ModelBilling Instructions for Investigational Device Exemptions (IDEs)Local Coverage Determinations (LCDs)Reminder on Billing Requirements Implemented for non-OPPS ProvidersMedicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingEducational Resources to Assist Chiropractors with Medicare BillingPlease Do Not Email Protected Health Information (PHI)Entering Beneficiary Information: eServices Eligibility Inquiry vs. Claim SubmissionProvider Contact CenterPhysicians, Are You Ordering Glucose Monitors and Supplies for Your Patients?COVID-19 Vaccines and Monoclonal Antibodies Administration AllowancesMasking of Patient Control Number/Patient Account Number Field on Paper Remittance Advice Began October 1, 2019Did You Know DME MACs Offer Resources for Physicians?Appropriate Usage of the Modifier for a Distinct Procedural Service, Other Than E/M Services2019 Payment Adjustment RemindersMedicare's Telehealth Benefit: Clarification from the Durable Medical Equipment MACsPhysicians! Are You Ordering Oxygen for Your Patient?Intensive Behavioral Therapy (IBT) for ObesityLooking for Medicare Coverage Information?Important Tax Information - 1099 FormsBankruptcyPolysomnography (Sleep Study)Alcohol Misuse Screening and CounselingUnsolicited Fax or Email InquiryHow To Recognize an SMRC AuditCMS Advanced Care Planning FAQsFOIA RequestsLocal Coverage Determinations: Find Them QuicklyPatient Resource Guide With Agency Names & NumbersNational Correct Coding Initiative (NCCI) ToolCare Plan Oversight ServicesMedicare Part B 2021 Final Rule: Evaluation and Management Changes - IntroductionHome Health ReferralsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentSave Time with eTicketCertifying Patients for the Medicare Home Health BenefitCMS Open Payments Data WebsiteNew Medicare Beneficiary Identifier (MBI) Get It, Use ItThe Stage 1 Meaningful Use Attestation CalculatorZIP Codes Eligible for HPSA Surgical Incentive Payment Program (HSIP) PaymentMedicare Quality Reporting Incentive programs ManualsCMS Claim Filing InstructionsMandatory Claims Filing RequirementsFraud and AbuseCollecting From Medicare PatientsEligibility for Medicare: BeneficiariesTeaching PhysiciansFederal Regulations: Anti-Kickback and Self-ReferralWhat Is Covered Under Medicare Part BSignature Requirements on Claims: Medicare PatientsAbout MedicareProvider Self Service ApplicationsHealth Professional Shortage AreasRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021Reminder: Additional Documentation Narrative Fax Cover SheetAssisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)MLN Connects for Thursday, May 13, 2021Cognitive Assessment & Care Plan ServicesTop Time-Saving Tools for Palmetto GBA ProvidersRemittance AdviceNew Editing Established for Federally Qualified Health Center and Rural Health Clinics'What If' and Scenario QuestionsMLN Connects Special Edition - Thursday, July 1, 2021MLN Connects Special Edition: Monday, August 2, 2021Medicare Coverage for Chiropractic Services: Medical Record Documentation Requirements for Initial and Subsequent VisitsInternet Only Manual Updates to Publication (Pub.) 100-02 to Implement Updates to Policy and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF))New Waived TestsInternet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)Biden-Harris Administration Takes Additional Action to Protect America's Nursing Home Residents from COVID-19Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Health Care (CAQH) COREMedicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)Annual Clotting Factor Furnishing Fee Update 20222022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentClaims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve RegurgitationOctober 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemInfluenza Vaccine Payment Allowances - Annual Update for 2021-2022 SeasonOctober Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - January 2022Medicare Clarifies Recognition of Interstate License Compacts PathwaysTraining Medicare Patients on Use of Home Glucose Monitors and Related Billing InformationQuarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesChanges to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022Claim Status Category and Claim Status Codes UpdateNational Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy2022 Medicare Physician Fee Schedule (MPFS) Payment Rates and Participation ProgramInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 2 of 2)MLN Connects for Thursday, November 4, 2021Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationNew Waived Tests2022 Annual Update of Per-Beneficiary Threshold AmountsMedicare Part B CLFS: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System2022 Annual Update to the Therapy Code ListRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateNational Expansion of the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization ModelSkilled Nursing Care and Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: ReminderReduced Payment for Physical Therapy and Occupational Therapy Services Furnished in Whole or In Part by a Physical Therapist Assistant or an Occupational Therapy AssistantUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2022Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication (Pub.) 100-08Calendar Year 2022 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSummary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services ListServices Outside the United StatesFee-For-Time Compensation Arrangements (Formerly Locum Tenens Arrangements)Medicare Diabetes Prevention Program (MDPP) Service Period Change from 2 Years to 1 YearAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 86328Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) Section 240.6January 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemChanges to the Laboratory National Coverage Determination (NCD) Edit Software for April 2022Provider ResponsibilitySkin Substitute CodesCalendar Year (CY) 2022 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - April 2022 (CR 1 of 2)Standard Elements for DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization RequirementsWays to Connect to Palmetto GBACY2022 Telehealth Update Medicare Physician Fee ScheduleHealthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsClinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of SpecimensQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentNational Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2022 UpdateInternet-Only Manual Updates for Critical Care Evaluation and Management ServicesInternet-Only Manual Updates (IOM) for Critical Care, Split/ Shared Evaluation and Management Visits, Teaching Physicians, and Physician AssistantsApril Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleApril 2022 Release Dark Days for the Common Working File (CWF) HostsApril 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemRemittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateClaims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20-valent Conjugate Vaccine Code 90677Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemUnsolicited Voluntary RefundsUpdate to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID-19) and its Administration to Current Claims Processing Requirements and Other General UpdatesNew Waived TestsCWF Editing - National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) - July 2022Changes to Beneficiary Coinsurance for Additional Procedures Furnished During the Same Clinical Encounter As Certain Colorectal Cancer Screening TestsUpdate of Internet Only Manual (IOM), Pub. 100-04, Chapter 15 - AmbulanceCalendar Year 2023 Modifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationNational Coverage Determination (NCD) 210.14 Reconsideration - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)MLN Connects for Thursday, May 5, 2022Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentMLN Connects for Thursday, May 12, 2022MLN Connects for Thursday, May 19, 2022MLN Connects for Thursday, May 26, 2022New/Modifications to the Place of Service (POS) Codes for TelehealthAn Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of CoverageUpdate to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) ServicesMLN Connects for Thursday, June 2, 2022Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2MLN Connects for Thursday, June 9, 2022Medicare Provider Alert - Your Responsibility When Using OutsourcersComprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023Correct Date of Service for Specific ServicesJuly Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleMLN Connects for Thursday, June 16, 2022MLN Connects Special Edition: Tuesday June 21, 2022International Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs)-October 2022International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021MLN Connects for Thursday, June 23, 2022Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print UpdateJuly 2022 Update of the Ambulatory Surgical Center (ASC) Payment SystemChanges to the Laboratory National Coverage Determination (NCD) Edit Software for October 2022MLN Connects for Thursday, June 30, 2022MLN Connects for Thursday, July 7, 2022Electronic Claims and Additional DocumentationMLN Connects Special Edition: Thursday, July 7, 2022Services and Circumstances that Require Additional DocumentationMLN Connects for Thursday, July 14, 2022MLN Connects Special Edition for Friday, July 15, 2022MLN Connects for Thursday, July 21, 2022MLN Connects Special Edition for Wednesday, July 27, 2022MLN Connects for Thursday, July 28, 2022MLN Connects Special Edition: Friday, July 29, 2022MLN Connects Special Edition: Monday, August 1, 2022eTicket Enables Providers to Save Time with Every CallMLN Connects for Thursday, August 4, 2022New Waived TestsPayment Allowance Update for COVID-19 Monoclonal Antibody Therapy Q0222 Injection, Bebtelovimab, 175 mgIf You've Contacted Us Recently, We Would Love to Hear About Your Experience!