News
- CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices
- Clinical Diagnostic Laboratories: Required Reporting Starts May 1
- HETS Action Required: Enroll Third-Party Vendors for Access by May 11
- Nurses May Qualify for Up to $40,000 in Student Loan Repayment
- Reduce Chronic Disease & Improve Health with Physical Activity and Nutrition
Compliance
Claims, Pricers & Codes
Events
MLN Matters® Articles
- Vaccine Administration National Fee Schedule: July 2026 Quarterly Update
- Stay of Enrollment – Revised
Publications & Multimedia
- Clinical Laboratory Fee Schedule: Reporting Private Payor Data
- Fix Death Date Errors in Medicare Records
News
CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices
CMS and the FDA announced the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway, a new pathway designed to expedite access to certain FDA-designated Class II and Class III Breakthrough Devices for people with Medicare.
Read the full press release.
Clinical Diagnostic Laboratories: Required Reporting Starts May 1
Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? If so, you must report data from May 1 – July 31, 2026, based on an updated data collection period of January 1 – June 30, 2025, including:
- Applicable HCPCS codes
- Associated private payor rates
- Volume data
How do I report?
- Review CLFS Data Collection System resources:
- View the applicable HCPCS codes (ZIP)
- Use the Data Reporting Template (ZIP)
More Information:
- CLFS & PAMA Reporting and Resources webpage
- CLFS: Reporting Private Payor Data (PDF) booklet
- CLFS (PDF) fact sheet
- FAQs
- Is My Lab an Applicable Lab? video
HETS Action Required: Enroll Third-Party Vendors 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 your enrollment by May 11 to ensure uninterrupted service. If your Medicare eligibility transactions fail with AAA error code "41" (no current, valid, relationship between the NPI and the third-party vendors), it may be due to incomplete enrollment. To prevent disruption to your services, finalize all enrollment requirements before May 11.
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
Nurses May Qualify for Up to $40,000 in Student Loan Repayment
CMS is highlighting information on how nurses who work in a nursing home may qualify for significant financial support, including up to $40K in student loan repayment and up to $10K as an incentive stipend. Applications are expected to go live later this year.
Nursing home staffing is a critical factor in improving care for nursing home residents. We’re committed to improving safety and quality of care in the nation’s nursing homes. These financial incentives are aimed at increasing the availability of qualified nurses to work in nursing home settings.
Reduce Chronic Disease & Improve Health with Physical Activity and Nutrition
Encourage your patients to develop healthy physical activity and eating habits. CMS recently finalized a new HCPCS code (G0136) for a physical activity and nutrition risk assessment as an add-on code for Evaluation and Management (E/M) visits (every 6 months) or the Annual Wellness Visit.
More Information:
- Annual Wellness Visit webpage
- E/M Services (PDF) booklet
- Medicare & Mental Health Coverage (PDF) booklet
- Medicare Physician Fee Schedule Final Rule Summary: CY 2026 (PDF) MLN Matters® article
Compliance
Manual Wheelchairs: Prevent Claim Denials
In 2024, the improper payment rate for manual wheelchairs was 30.5%, with a projected improper payment amount of $28.1M. Learn how to bill correctly for these services. Review the Manual Wheelchairs provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
Claims, Pricers & Codes
Ultrasound Abdominal Aortic Aneurysm Screening: Updated Coding Information
CMS updated abdominal aortic aneurysm screening codes in the Medicare Claims Processing Manual, Chapter 18 (PDF), section 110.3.2, consistent with preventive service guidance. We added ICD-10 diagnosis code Z13.6 in combination with either Z87.891, F17.210, F17.211, F17.213, F17.218, F17.219, or Z84.89.
See the instruction to your Medicare Administrative Contractor (PDF).
Events
CCSQ Quarterly Stakeholder Webinar – May 12
Tuesday, May 12 from 12–1 pm ET
Register for this webinar.
You’re invited to join Dr. Dora Hughes, Chief Medical Officer of CMS and Director of the Center for Clinical Standards and Quality (CCSQ), and the CCSQ leadership team for an engaging update on our work to strengthen health care quality, safety, and coverage. Hear the latest on recent policy developments and how these efforts are accelerating progress toward improving care and outcomes for beneficiaries in Medicare, Medicaid, and the Marketplace.
MLN Matters® Articles
Vaccine Administration National Fee Schedule: July 2026 Quarterly Update
Learn about coding updates (PDF) for TOFIDENCE® (tocilizumab-bavi) for intravenous administration in hospitalized adults with COVID-19.
Stay of Enrollment – Revised
We added additional scenarios (PDF) for when a stay of enrollment status may apply to DMEPOS suppliers.
Publications & Multimedia
Clinical Laboratory Fee Schedule: Reporting Private Payor Data
CMS implemented changes that require reporting entities to report certain private payor rate information for their component applicable laboratories to us. Learn about (PDF):
- Clinical Laboratory Fee Schedule
- Applicable labs and reporting entities
- Applicable information
- Data collection and reporting
- Resources
Fix Death Date Errors in Medicare Records
Sometimes Medicare records incorrectly show that a patient has died, or the records list the wrong date of death. When this happens, Medicare will not pay the claim until we get a correction. Learn about (PDF):
- Where these errors come from
- How to fix incorrect dates of death
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