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May and June 2026 Medicare Updates

Published on 

Thursday, July 2, 2026

 | Billing 
 | Case Management 
 | Documentation 
 | Medicare Coverage 

Medicare Transmittals & MLN Articles

 

May 5, 2026: MLN MM14354: Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirements

This article was first published on January 29, 2006. With this second iteration CMS has added HCPCS code G0491 to the billing requirements for acute kidney injury hemodiafiltration claims. As a reminder, starting July 1, 2026, ESRD facilities don’t need to submit the AX modifier on claims eligible for certain add-payment adjustments under ESRD PPS and facilities must adhere to new billing instructions for hemodiafiltration and AKI claims. https://www.cms.gov/files/document/mm14354-acute-kidney-injury-esrd-billing-ending-ax-modifier-requirement.pdf

 

May 27, 2026: MLN MM14468: Rural Health Clinics & Federally Qualified Health Centers: Billing Distant Site Telehealth Services

Make sure your billing staff knows that RHCs and FQHCs must bill the individual CPT or HCPCS code for distant site telehealth services they provide instead of HCPCS code G2025, effective October 1, 2026. https://www.cms.gov/files/document/mm14468-rural-health-clinics-federally-qualified-health-centers-billing-distant-site-telehealth.pdf

 

June 2, 2026: MLN MM14464: ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2026

Make sure your billing staff knows about NDCs with new or deleted ICD-10 diagnosis codes effective October 1, 2026. Relevant coding changes in the related Change Request (CR)14464 include:

NCD 20.4 – Implantable Cardioverter Defibrillations (ICDs)

NCD 90.2 – Next Generation Sequencing (NGS)

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis

NCD 110.23 – Stem Cell Transplant

NCD 110.24 – Chimeric Antigen Receptor (CAR) T-cell Therapy

NCD 150.3 – Bone (Mineral) Density Studies

NCD 220.6.1 – PET for Perfusion of the Heart

NCD 250.4 – Treatment of Actinic Keratosis

https://www.cms.gov/files/document/mm14464-icd-10-other-coding-revisions-national-coverage-determinations-october-2026-update.pdf

 

June 18, 2026: MLN MM14477: Hospital Outpatient Prospective Payment System: July 2026 Update

Make sure your billing staff knows about the OPPS updates effective July 1, 2026, for example CMS has approved two new drugs (TOFIDENCE® and ACTEMRA®) for intravenous administration in hospitalized adults with COVID-19 who get systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation. Effective July 1, 2026 CMS has established HCPCS code Q0234 to describe TOFIDENCE to treat COVID-19 and the associated HCPCS administrative codes M0231 and M0232. https://www.cms.gov/files/document/mm14477-hospital-outpatient-prospective-payment-system-july-2026-update.pdf

 

Coverage Updates

 

June 4, 2026: CMS GLP-1 Bridge Starting July 1, 2026

In the June 4, 2026 edition of MLN Connects, CMS released educational materials to support the Medicare GLP-1 Bridge set to start on July 1, 2026. Through this short-term demonstration, CMS is expanding access to certain GLP-1 medications to eligible Part D beneficiaries who do not currently have access to these medications through the Part D benefit. The GLP-1 Bridge demonstration will be from July 1, 2026 through December 31, 2027.

 https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-june-4-2026

Link to CMS.gov GLP-1 Bridge webpage: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge

 

June 8, 2026: Final Decision Memo: Screening for Colorectal Cancer-Non-Invasive Biomarker Tests

CMS final decision is that noninvasive biomarker colorectal cancer screening tests are covered once every three years when all ordering, patient and test criteria in this policy are met.

https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=319

 

June 15, 2026: CMS Published Proposed Decision Memo for NCD 20.32: Transcatheter Aortic Valve Replacement

The TAVR NCD 20.32 first became effective May 1, 2012 for the treatment of symptomatic aortic valve stenosis. The second iteration of this policy was effective June 21, 2019. This most recent reconsideration was initiated by Ewards Lifesciences in July 2025 indicating a “reconsideration is needed to reflect new published evidence demonstrating improved outcomes with the use of TAVR for asymptomatic patients that are beyond the scope of the current NCD, as well as additional evidence supporting the removal of coverage with evidence development (CED) and other outdated requirements in the NCD.”

 

CMS has proposed to:

  • Cover TAVR for symptomatic severe aortic valve stenosis without the CED requirement,
  • Expand coverage to asymptomatic severe AS with CED, and
  • Review coverage criteria related to pre-procedural patient assessment, intraoperative requirements, and operator and hospital procedural volume requirements.

The public comment period is through July 15, 2026. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&ncaid=321&fromTracking=Y&doctype=all&timeframe=30&sortBy=updated&bc=21

 

June 17, 2026: June Update to CMS National Coverage Determination (NCD) Dashboard

CMS indicates “at a glance” there are two open NCDs, six NCDs have been finalized in the past 12 months, there are no pending Transitional Coverage for Emerging Technologies (TCET) topics, and eleven topics are on the NCD wait list. To learn more about the open, latest, and pending NCDs topics click here https://www.cms.gov/files/document/ncddashboard.pdf.

 

Compliance Education Updates

 

May 2026: MLN97302356: Skilled Nursing Facility 3-Day Rule Billing

CMS has updated this MLN Fact Sheet to include information on the Transforming Episode Accountability (TEAM) Skilled Nursing Facility (SNF) 3-Day Rule Waiver. https://www.cms.gov/files/document/skilled-nursing-facility-3-day-rule-billing.pdf

 

Other Updates

 

June 5, 2026: ICD-10-CM/PCS Updates

The FY 2027 ICD-10-PCS procedure code files and guidelines have been posted to the CMS.gov ICD-10 webpage. Use these codes for discharges on or after October 1, 2026 through March 31, 2027.

 

The FY 2027 ICD-10-CM diagnosis code files (POA Exempt Codes, Conversion Table, Code and Descriptions in Tabular Order, Addendum, and Code Tables, Tabular and Index) has also been posted to this webpage. Use these codes for discharges on or after October 1, 2026 through September 30, 2027.

https://www.cms.gov/medicare/coding-billing/icd-10-codes

 

June 16, 2026: Final Rule CMS-3367-FC: Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions

 

CMS notes in the Federal Register that “This final rule with comment period sets forth provisions to strengthen the oversight of Medicare national accrediting organizations by addressing conflicts of interest, establishing consistent standards, processes, and definitions, and updating the validation and performance standards systems. Additionally, this final rule with comment period revises the psychiatric hospital survey process, adds a limitation on terminated deemed providers and suppliers when reentering the program, and provides technical corrections for End-Stage Renal Disease facilities and Transplant Programs.”

 

A related CMS Memorandum to State Survey Agencies and AOs was also issued on June 16, 2026. The three points made by CMS in the memorandum summary are 1) they are providing information on the requirements for the new AO oversight rule published on June 16, 2026 (91 FR 36370), 2) these regulations are effective 1 (one) year after publication at the Federal Register, and 3) they are raising awareness to ensure providers and suppliers deemed under a CMS approved AO become familiar with the upcoming changes that could impact them.

 

CMS also provided the guidance that “For the provider and supplier community and those facilities deemed under a CMS-approved AO, your respective AO is expected to communicate with your organization regarding these requirements, including the requirement that AOs must adopt the same language in the Medicare conditions for their respective AO program standards.”

 

Resources

 

June 18,2026: Q1 FY 2026 PEPPER Released

CMS announced the release of the Q1 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. According to CMS, hospitals can use this report to:

  • Spot billing patterns that may need improvement,
  • Identify areas that may need audits or closer monitoring,
  • Find diagnosis-related groups (DRGs) that may be under-coded or over-coded, and
  • Track areas where patient stays are getting lower.

You can read the CMS announced in the June 18 edition of MLN Connects at https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-june-18-2026

 

June 30, 2026: FY 2027 ICD-10-CM Official Guidelines for Coding and Reporting

CDC has released the updated guidelines effective October 1, 2026. While there are few changes to the guidelines, it is a good refresher for seasoned professionals and a learning tool for new coding and Clinical Documentation Integrity professionals. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.