Knowledge Base Article

Medicare Transmittals & MLN Articles

 

June 25, 2026: MLN MM14522: Ambulatory Surgical Center Payment System: July 2026 Update

Make sure your billing staff knows about the ASC payment system updates effective July 1, 2026, for example CMS has approved one new device pass-through status under the Hospital OPPS, and they are establishing the new device category in the ASC payment system. The new HCPCS code C1609 (vertebral device, motion preserving with screw fixation is effective July 1, 2026. https://www.cms.gov/files/document/mm14522-ambulatory-surgical-center-payment-system-july-2026-update.pdf

 

July 7, 2026: MLN MM14513: DMEPOS Fee Schedule: July 2026 Quarterly Update

Make sure your billing staff knows about guidance on continuing the KF modifier on claims for non-invasive osteogenesis stimulators (HCPCS codes E0747, E0748, and E0760) for dates of service on or after May 18, 2026. https://www.cms.gov/files/document/mm14513-dmepos-fee-schedule-july-2026-quarterly-update.pdf

 

July 9, 2026: HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update

Make sure your billing staff knows about the 19 new HCPCS codes CMS is adding to the home health (HH) consolidated billing (CB) non-routine supply code list, effective October 1, 2026. https://www.cms.gov/files/document/mm14510-hcpcs-codes-used-home-health-consolidated-billing-enforcement-october-2026-quarterly-update.pdf

 

July 10, 2026: MLN MM14495: Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology

Make sure your billing staff knows to use a modifier or G code on hospice claims when reporting face-to-face encounters for recertification using telecommunications technology, starting January 1, 2027. https://www.cms.gov/files/document/mm-14495-hospice-claims-reporting-face-face-encounter-recertification-using-telecommunications.pdf

 

Coverage Updates

 

July 7, 2026: MLN MM14536: Laboratory National Coverage Determination Edit Software: October 2026 Update

Make sure your billing staff knows about eleven National Coverage Determinations (NCDs) with added and deleted ICD-10-CM Codes for the October 2026 updates. https://www.cms.gov/files/document/mm14536-laboratory-national-coverage-determination-edit-software-october-2026-update.pdf

July 30, 2026: National Coverage Analysis: Autologous Stem Cell Transplantation (AuSCT) for Multiple Myeloma)

The American Society of Hematology, Association of Cancer Care Centers, Corewell Health, International Myeloma Foundation, and Medical University of South Carolina, Hollings Cancer Center submitted a request CMS amend NCD 110.23 regarding coverage of autologous stem cell transplantation (AuSCT) to include a disease staging system for multiple myeloma supported by current clinical guidelines. CMS has published a Proposed Decision Memo and are accepting comments until August 29, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=323

 

Compliance Education Updates

 

July 2026: MLN Fact Sheet: MLN908764: Medicare Part D Vaccines

CMS reviewed this Fact Sheet in July. Even though there were no substantive changes, this is a good resource to understand what vaccines Medicare Parts B and D covers. https://www.cms.gov/files/document/mln908764-medicare-part-d-vaccines.pdf

 

July 2026: MLN Fact Sheet: MLN7172818: Guiding an Improved Dementia Experience (GUIDE) Model

This 8-year voluntary national model started July 1, 2024 and offers a standardized approach to comprehensive dementia care, 24/7 access to an interdisciplinary care team member or help line, and caregiver education and support services, including respite services. Several substantive updates were made to this Fact Sheet in July. For example, the Model goals were updated to include the goal of improving coordination between care teams and community-based organizations. https://www.cms.gov/files/document/mln7172818-guiding-improved-dementia-experience-model.pdf

 

Other Updates

 

July 14, 2026: CY 2027 Medicare Physician Fee Schedule Proposed Rule

CMS is soliciting public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare part B issues (i.e., Medicare Shared Savings Program Requirements and Remote Monitoring).

 

You can read more about this proposed rule, including links to more information, in the Thursday, July 16, 2026 edition of CMS’ MLN Connects Newsletter at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-july-16-2026

 

CMS is accepting comments through August 31, 2026.

 

July 13, 2026: Medicare Beneficiary Date of Death: Manual Update

In the July 23, 2026 edition of MLN Connects, CMS alerts providers that a new section (210) has been added to the Medicare Claims Processing Manual, Chapter 1- General Billing Requirements. This section provides guidance on how to correct an incorrect date of death in Medicare records. CMS notes “Medicare records may incorrectly indicate that a patient has died or may list an incorrect date of death. When this occurs, Medicare won’t process claims for reimbursement until the error is corrected. This manual explains common causes of incorrect dates of death and the steps providers should take to resolve them.” The effective date for this new information is July 13, 2026.

 

Resources

Medicare Claims Processing Manual, Chapter 1: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c01.pdf

 

CMS MLN Fact Sheet (MLN7216774) March 2026: https://www.cms.gov/files/document/mln7216774-fix-death-date-errors-medicare-records.pdf

 

June 11, 2026 Transmittal 13826 (Change Request 14500): Subject: Medicare Beneficiary Date of Death – Manual Update: https://www.cms.gov/files/document/r13826cp.pdf

 

July 17, 2026: Required Remittance Advice Remark Codes Related to the No Surprises Act

CMS released guidance on the required remittance advice remark codes noting “these regulations are intended to improve communication between parties by ensuring that remittance advice include information relevant to adjudication of claims, including information used to determine whether a payment dispute is eligible for the Federal IDR process. These regulations are effective as of August 3, 2026.” https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/caa-nsa-rarc-codes.pdf

 

July 29, 2026: Fiscal Year 2027 Skilled Nursing Facility Final Rule (CMS-1843-F)

In this final rule, CMS finalized updates to the Skilled Nursing Facility (SNF) payment rates, “for an estimated increase of $882.74 million in aggregate payments to SNFs.”

 

July 29, 2026: Fiscal Year 2027 Inpatient Psychiatric Facility Final Rule (CMS-1847-F)

For FY 2027, CMS estimates payments to Inpatient Psychiatric Facilities (IPFs) would increase by 2.3%, or $60 million, in FY 2027, relative to IPF payments in FY 2026.

 

You can read more about the SNF and IPF final rules, including links to more information, in the Thursday, July 30, 2026 edition of CMS’ MLN Connects Newsletter at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-july-30-2026

 

July 31, 2026: Fiscal Year 2027 Inpatient Prospective Payment System and LTCH Final Rule

With the release of the Final Rule, CMS announced the expansion of the Comprehensive Care for Joint Model that ran from April 2016 through December 2024. The new Joint Replacement Expanded (CJR-X) Model will be the first expanded mandatory test of an episode-based payment model and will begin January 2028.

 

You can read more about the IPPS Final Rule, Inpatient Rehabilitation and Hospice Final Rules in an August 3, 2026 MLN Connects Special Edition at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-august-3-2026