Medicare Transmittals & MLN Articles
January 9, 2025: Travel Allowance Fees for Specimen Collection: CY 2026 Updates
This article provides information about CY 2026 revised payment allowances for HCPCS code P9603, the updated general specimen collection fee and travel allowance rate, and the HCPCS/CPT codes that describe specimen collection. https://www.cms.gov/files/document/mm14345-travel-allowance-fees-specimen-collection-cy-2026-updates.pdf
Coverage Updates
January 22, 2026: Incorrect ICD-10 diagnosis code for Vagus Nerve Stimulation
In the January 22, 2026 edition of the CMS newsletter MLN Connects, they noted that ICD-10 diagnosis code G47.33 (Obstructive Sleep Apnea) was incorrectly included as a covered indication for CPT code 64568 under National Coverage Determination (NCD) 160.18. This NCD is specific to vagus nerve stimulation for medical refractory partial onset seizures for whom surgery is not recommended or for whom surgery has failed and treatment-resistant depression. It is unrelated to OSA and coverage from ICD-10 diagnosis code G47.33 falls under the Medicare Administrative Contractor’s (MAC’s) discretion and isn’t mandated by the NCD. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-january-22-2026
January 30, 2026: MLN MM14302: National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension
This MLN article was initially released in December 2025. CMS updated it due to adding claims processing instructions for outpatient bill type 13X and allowable place of service codes 19 and 22 for professional claims, and they specified you may only use CPT 0935T for professional claims.
The implementation date for these instructions is April 6, 2026. CMS notes that the MACs “will return any RDN claims you submitted with the wrong TOB, POS, condition Code, modifier, or value code or claims that don’t include the clinical trial number. Your MAC will deny claims you submitted without the appropriate ICD-10-CM diagnosis codes. Note: Your MAC won’t search their files for RDN claims processed with dates of service or discharge dates from October 28, 2025 – April 6, 2026; however, they’ll adjust any claims you bring to their attention. https://www.cms.gov/files/document/mm14302-national-coverage-determination-20-40-renal-denervation-uncontrolled-hypertension.pdf
Compliance Education Updates
MLN Booklet: MLN006400: Information for Critical Access Hospitals
CMS made several changes to this booklet in December 2025, for example information has been added about the Transforming Episode Accountability Model (TEAM) skilled nursing facility 3-day rule waiver. https://www.cms.gov/files/document/mln006400-information-critical-access-hospitals.pdf
MLN Fact Sheet: MLN2259384: Rural Emergency Hospitals
CMS updated this fact sheet in December 2025 by adding the CY 2026 payment amount. https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf
MLN Booklet: MLN907165: Medicare Vision Services
Changes were made to this booklet in December 2025, for example a list of Medicare covered diseases for intravitreal injections was added and includes (neovascular (wet) age-related macular degeneration, macular edema following retinal vein occlusion, diabetic macular edema, and diabetic retinopathy). https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/visionservices_factsheet_icn907165.pdf
On a related note, the OIG published a report in May 2025 focused on Medicare payments for Evaluation and Management (E&M) services provided on the same day as eye injections at risk for noncompliance with Medicare requirements. Based on the audit findings, the OIG recommended that CMS update requirements for billing E&M services provided on the same day as intravitreal injections to help providers understand appropriate use of modifier 25, conduct medical reviews of E&M services, and recover payments of up to $124 million for those services that CMS determines should not have been billed with modifier 25 during the audit period (June 2022 through May 2023). https://oig.hhs.gov/documents/audit/10286/A-09-23-03014.pdf
Medicare Wellness Visits – New Webpage
CMS’ Medicare Wellness Visits MLN product is now a CMS.gov webpage. In the January 22, 2026 edition of MLN Connects they are changing some Medicare Learning Network® (MLN) products to webpages to improve user experience and content accessibility. https://www.cms.gov/medicare/coverage/preventive-services/medicare-wellness-visits
MLN Booklet: MLN901705: Telehealth & Remote Monitoring
CMS updated this booklet in December 2025. Several things have changed. For example, CMS permanently allows teaching and supervising physicians to supervise through virtual presence and 5 new CPT and HCPCS codes have been added to the Medicare telehealth services list. https://www.cms.gov/files/document/mln901705-telehealth-remote-monitoring.pdf
Other Updates
January 15, 2026: CMS Fact Sheet: Fiscal Year 2025 Improper Payments Fact Sheet
CMS opens this fact sheet by reminding the reader that CMS’ improper payment measurement is not a measure of fraud, and improper payments are not attributable to fraud and abuse. Instead, improper payments are payments that do not meet CMS program documentation, coding, and/or billing requirements. The estimated improper payment rate for Medicare Fee-for-Service (FFS) for FY 2025 was 6.55%, or $23.83 billion which is decreased from FY 2024’s estimated rate of 7.66%, or $31.70 billion. Unlike FFS, the improper payment rate for Medicare Part C or Medicare Advantage increased from $19.07 billion in FY 2024 to $23.67 billion in FY 2025. https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-improper-payments-fact-sheet
Beneficiary Notices MOON, IM, and DND Expired in 2025: Guidance from CMS
The Medicare Outpatient Observation Notice (MOON) (CMS-10611) expired on November 30, 2025 and the Important Message from Medicare (IM) (CMS-10065) and the Detailed Notice of Discharge (DND) (CMS-1066) expired December 31, 2025. As of the end of January 2026 new forms are not available. While we wait for CMS to work with the OMB to reauthorize this information collection, providers may continue to use the current version of the notices until CMS provides further instructions. When the forms are available, CMS has indicated they will notify the industry through their website, the Health Plan Management System (HPMS), and the Medicare Learning Network. At that time, providers will have 60 calendar days from the date of the CMS announcement to begin using the updated MOON, IM/DND. https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative
