Knowledge Base Article

Medicare Transmittals & MLN Articles

 

January 29, 2026: MLN MM14354: Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement

Make sure your billing staff knows about July 1, 2026 updates to billing instructions for ESRD Prospective Payment System (PPS) claims and to the Medicare Claims Processing Manual, Chapter 8, sections 20, 40, and 50.

https://www.cms.gov/files/document/mm14354-acute-kidney-injury-esrd-billing-ending-ax-modifier-requirement.pdf

 

January 29, 2026: MLN MM14359: Ambulatory Surgical Center Payment: January 2026 Update

This article provides information on updates effective January 1, 2026 related to new device categories, CPT codes, and HCPCS codes, drugs and biologicals, skin substitutes, and non-opioid treatments for pain relief. https://www.cms.gov/files/document/mm14359-ambulatory-surgical-center-payment-january-2026-update.pdf

 

February 20, 2026: MLN MM14371: Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: April 2026 Update

Make sure your billing staff knows about Clinical Laboratory Fee Schedule (CLFS) Updates including the next data reporting period for clinical diagnostic laboratory tests (CDLTs), and new CPT codes, effective April 1, 2026.

https://www.cms.gov/files/document/mm14371-clinical-laboratory-fee-schedule-laboratory-services-subject-reasonable-charge-payment-april.pdf

 

February 20, 2026: MLN MM14372: HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2026

Make sure your billing staff knows about discontinued codes, new codes, and codes subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits. https://www.cms.gov/files/document/mm14372-hcpcs-codes-clinical-laboratory-improvement-amendments-edits-april-2026.pdf

 

February 20, 2026: MLN MM14390: Vaccine Administration National Fee Schedule: April 2026 Udpate

Make sure your billing staff knows about the coding updated for TYENNE® (tocilizumab-aazg) for intravenous administration in hospitalized adults with COVID-19. https://www.cms.gov/files/document/mm14390-vaccine-administration-national-fee-schedule-april-2026-update.pdf

 

Coverage Updates

February 9, 2026: MLN MM14356: ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update

Make sure your billing staff knows about updates to the National Coverage Determinations (NDCs) with new or deleted ICD-10 diagnosis codes, effective July 1, 2026. NCDs with coding changes in Change Request (CR) 14356 include:

 

NCD 90.2 – Next Generation Sequencing (NGS)

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis

NCD 150-13 – Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis

NCD 160.18 – Vagus Nerve Stimulation (VNS)

NCD 210.10 – Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs

NCD 220.6.17 – Positron Emission Tomography (PET) (FDG) for Oncologic Conditions

NCD 250.4 – Treatment of Actinic Keratosis

https://www.cms.gov/files/document/mm14356-icd-10-other-coding-revisions-national-coverage-determinations-july-2026-update.pdf

 

February 13, 2026: Change Request (CR) 14253: Update to Claims Processing Instructions for NCD 20.4 Implantable Cardiac Defibrillators (ICDs)

The purpose of this CR is to cover eleven procedure codes for the extravascular ICD (EV-ICD) system. https://www.cms.gov/files/document/r13641CP.pdf

 

February 17, 2026: MLN MM14302: National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension

This third iteration of this document was published to update the CR release date, transmittal numbers, and transmittal links. No substantive changes were made. https://www.cms.gov/files/document/mm14302-national-coverage-determination-20-40-renal-denervation-uncontrolled-hypertension.pdf

 

February 25, 2026: NCD 110.17 Anti-cancer Chemotherapy for Colorectal Cancer

CMS is removing this NCD. They noted in the final Decision Memo (CAG-00179R) “removing this NCD does not end the opportunity for coverage for these agents. Other coverage mechanisms exist including the Clinical Trial Policy NCD 310.12 and, separately, off-label use of anti-cancer chemotherapeutic agents are coverable according to §1861 (t)(2)(B) of the Social Security Act (the Act).” https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=320

 

Compliance Education Updates

 

December 2025: MLN Educational Tool: MLN006559: Medicare Preventive Services

CMS made changes to this Educational Tool in December 2025 to reflect changes in effect in 2026, including:

• Annual wellness visit: Updated description for HCPCS code G0136, effective January 1, 2026
• Medicare Diabetes Prevention Program: 
• Added HCPCS code G9871, effective January 1, 2026
• Updated the extended flexibilities period to December 31, 2029
• Updated that sessions can also be held online through December 31, 2029
• Office and outpatient evaluation and management (E/M) visit FAQ: Starting January 1, 2026, you can bill G2211 as an add-on code with the home or residence E/M visits code family

 

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html

 

January 2026: MLN Booklet: MLN909432: Behavioral Health Integration Services  

This booklet has been updated to add three new optional add-on HCPCS codes for general behavioral health integration and psychiatric collaborative care model services when advanced primary care management services are provided. https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf

 

January 2026: MLN Booklet: MLN006398: Information for Rural Health Clinics

Several changes have been made to this booklet. For example, CMS has permanently adopted the definition of direct supervision to include supervision through audio-visual telecommunications technology. https://www.cms.gov/files/document/mln006398-information-rural-health-clinics.pdf

 

February 2026: MLN Fact Sheet: MLN3191598: Intravenous Immune Globulin Items & Services

This MLN Fact Sheet has been updated to include the CY 2026 payment rate for HCPCS code Q2052. https://www.cms.gov/files/document/mln3191598-intravenous-immune-globulin-items-services.pdf

 

February 2026: MLN Booklet: MLN34893002: Medicare Diabetes Prevention Program Expanded Model

Several changes were made to this MLN booklet with the February 2026 update. For example, the list or organization types that can become Medicare Diabetes Prevention Program (MDPP) suppliers has been expanded to include virtual-only organizations. https://www.cms.gov/files/document/mln34893002-medicare-diabetes-prevention-program-expanded-model.pdf

 

Other Updates

 

February 2, 2026: CMS Updates Telehealth FAQs

The consolidated Appropriations Act, 2026 signed into law on February 3, 2026, extends Medicare telehealth flexibilities through December 31, 2027. CMS updated their telehealth FAQ document on February 4, 2026. https://www.cms.gov/files/document/telehealth-faq-updated-02-04-2026.pdf

 

February 20, 2026: New MOON

The Office of Management and Budget (OMB) has reauthorized the Medicare Outpatient Observation Notice (MOON) (CMS-106611). Per CMS, “the MOON is effective now and expires February 28, 2029. Providers who have existing stock of the expired MOON may continue to use the expired version until April 20, 2026, but must transition to the new form no later than that date.”

 https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative

 

February 25, 2026: Initiative Seeks Input on Strengthening Program Integrity to CRUSH Fraud

In a CMS press release, the White House, HHS, and CMS “announced new steps to crack down on fraud in Medicare and Medicaid to protect patients and taxpayers and improve affordability.” HHS Secretary Kennedy noted “we are replacing the old ‘pay and chase’ model with a real-time ‘detect and deploy’ strategy, using advanced AI tools to identify fraud instantly and stop improper payments before they go out the door.”

 

CMS is asking for input from stakeholders on ways to tackle fraud prevention to help with development of a likely future rule under CMS’ Comprehensive Regulations to Uncover Suspicious Health (CRUSH) initiative. For example, CMS is seeking input regarding reducing fraudulent Medicare Parts A and B claim submissions and have asked the question: “How would a claim filing deadline of 90 or 180 calendar days, which is consistent with private industry norms, impact your practice?”

 

Comments must be received by March 30, 2026.

 

CMS Press Release:  https://www.cms.gov/newsroom/press-releases/trump-administration-prioritizes-affordability-announcing-major-crackdown-health-care-fraud

 

CMS Request for Information (RFI) Related to Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH): https://www.federalregister.gov/documents/2026/02/27/2026-03968/request-for-information-rfi-related-to-comprehensive-regulations-to-uncover-suspicious-healthcare

 

February 26, 2026: Therapy Services CY 2026 KX Modifier Threshold Amounts

The CY 2026 KX modifier threshold amount for CY 2026 is $2,480 for physical therapy and speech-language pathology combined, and occupational therapy services. You can find links to more information about therapy services in the February 26, 2026 edition of MLN Connects at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-february-26-2026.