News
- CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System
- HETS Action Required: Enroll Third-Party Vendor for Access by May 11
- ACCESS Model Application Period Extended to May 15; First Applicants Accepted to Join
- DMEPOS Therapeutic Shoes: Document Qualifying Conditions
MLN Matters® Articles
- Ambulatory Surgical Center Payment System: April 2026 Update
- Critical Access Hospitals: Certified Registered Nurse Anesthetist Bypass for Reason Codes 31006 & 31007
- Prospective Payment System Hospital Interim Billing: New Monthly Adjustment Process
- Cardiac Contractility Modulation for Heart Failure – Revised
Publications & Multimedia
News
CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System
A major leap forward in modernizing America’s health care system was announced during the CMS HealthTech Ecosystem Live! First Wave Launch event, which brought together CMS infrastructure, a new Medicare App Library, and an initial set of patient-facing applications to move the nation beyond clipboards, fax machines, and repetitive paperwork into a seamless, digital-first era.
As part of the event, interoperable digital tools were introduced intended to streamline care and improve the patient experience. Highlights included:
- Digital data access and check-in (“Kill the Clipboard”): Allowing patients to securely share information with a simple scan on their phone
- Personalized health applications: Offering tailored guidance on nutrition, wellness, and chronic disease management—extending care beyond clinic walls
Visit the Health Technology Ecosystem webpage for more information.
HETS Action Required: Enroll Third-Party Vendor for Access by May 11
Providers using third-party vendors to check Medicare beneficiary eligibility must now enroll these vendors with CMS for HIPAA Eligibility Transaction System (HETS) access by linking each vendor to your NPI.
If you haven’t already enrolled, visit HETS EDI: How to Enroll, and follow these steps:
- Contact your vendor promptly
- Obtain their unique ID
- Use the ID to enroll and link the vendor to your NPI so they can continue submitting eligibility inquiries
Complete enrollment by May 11 to avoid service disruption.
If you opt not to enroll, you may still check eligibility through your Medicare Administrative Contractor’s secure internet portal. After enrollment, you’ll receive monthly transaction volume reports for each vendor you enrolled.
Questions?
- For report questions, contact your vendor
- If you have concerns about your NPI being misused to check eligibility, contact mcare@cms.hhs.gov
ACCESS Model Application Period Extended to May 15; First Applicants Accepted to Join
What’s New
More than 150 leading health care organizations have been accepted to participate in the launch of the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model.
Why It Matters
Most of the organizations have not previously served Medicare beneficiaries and will bring additional technology-supported care options to help people manage chronic conditions like high blood pressure, diabetes, chronic pain, and depression.
What to Expect
CMS extended the initial application deadline to May 15, 2026, so that more organizations can participate in ACCESS when it launches on July 5, 2026; Medicare enrollment is required for participation but not to apply.
The Big Picture
ACCESS empowers people with Medicare and their clinicians by offering new chronic care options that are convenient, affordable and integrated with their existing care teams. Clinicians can also bill a new co-management payment for coordinating care with ACCESS organizations.
More Information
- Request for Applications (PDF)
- Accepted Applicants
- CMS Innovation Center Strategic Direction
- Value-based Care Spotlight
- Innovation Insights
DMEPOS Therapeutic Shoes: Document Qualifying Conditions
Industry asked CMS to clarify our requirement to document the presence of the qualifying condition(s) necessary for payment of therapeutic shoes. There are 2 longstanding options to meet that requirement:
- Personal documentation by the certifying physician in their own medical records, or
- Co-signed notes of the podiatrist or other physician or practitioner
More Information:
- Therapeutic Shoes for Persons with Diabetes Local Coverage Determination
- Therapeutic Shoes for Persons with Diabetes Policy Article
- Therapeutic Footwear provider compliance tip
MLN Matters® Articles
Ambulatory Surgical Center Payment System: April 2026 Update
Learn about updates (PDF), effective April 1, 2026:
- New Hospital Outpatient Prospective Payment System device pass-through category payable in ambulatory surgical centers (ASCs)
- New HCPCS codes and payment status changes for:
- ASC surgical procedures
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitute products
- Qualifying non-opioid treatments for pain relief
Critical Access Hospitals: Certified Registered Nurse Anesthetist Bypass for Reason Codes 31006 & 31007
Learn about system edits (PDF) to prevent critical access hospital certified registered nurse anesthetist outpatient service claims from getting reason codes 31006 and 31007 if they have a valid pass-through on file.
Prospective Payment System Hospital Interim Billing: New Monthly Adjustment Process
Learn about updates (PDF), effective for hospital discharges on or after October 1, 2024:
- New monthly adjustment process for Prospective Payment System hospital inpatient claims
- Enforcing correct interim billing procedures by verifying patient status and correctly applying benefit days
Cardiac Contractility Modulation for Heart Failure – Revised
We added information (PDF) for HCPCS codes C1824, C1898, and K1030.
Publications & Multimedia
Annual Wellness Visit – Revised
CMS updated HCPCS code G0136 and related content.
Clinical Laboratory Fee Schedule – Revised
CMS added (PDF):
- The next data reporting period, which starts May 1, 2026
- That there’s no phase-in payment reduction for CY 2026
- The payment reduction cap for CYs 2027–2029, which is 15%
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