News
Compliance
Claims, Pricers & Codes
- Encelto™ Cell Gene Therapy Drug: Get Billing Guidance
- HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items & Services
Events
- CCSQ Quarterly Stakeholder Webinar – August 26
- CMS National Provider Enrollment Conference — November 18 & 19
MLN Matters® Articles
Publications & Multimedia
From Our Federal Partners
News
DMEPOS Competitive Bidding Program: Get Ready for Round 2028
CMS posted new fact sheets on the Competitive Bidding Implementation Contractor (CBIC) website to help bidders continue preparing for Round 2028 of the DMEPOS Competitive Bidding Program (CBP):
- Antitrust Guidance fact sheet
- Common Ownership & Common Control fact sheet
- Determining the Number of Contract Awards & Calculating a Single Payment Amount fact sheet
- Round 2028 Terms & Definitions fact sheet
These fact sheets cover key requirements and rules to help you submit an informed, competitive bid.
We also updated information on the bid surety bond amount for a remote item delivery competitive bidding area based on the release of the FY 2027 Inpatient Rehabilitation Facility Prospective Payment System final rule.
What you should do:
- Visit the CBIC website – the official source for bidder information and education
- Review the new fact sheets as soon as possible
- Use these resources to understand DMEPOS CBP requirements before the bidding period opens
Compliance
Comprehensive Outpatient Rehabilitation Facility Services: Prevent Claim Denials
In 2024, the improper payment rate for comprehensive outpatient rehabilitation facility (CORF) services was 45.4%, with a projected improper payment amount of $10.8 million. Learn how to bill correctly for these services. Review the CORF Services provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Payment and documentation requirements
- Resources
Claims, Pricers & Codes
Encelto™ Cell Gene Therapy Drug: Get Billing Guidance
Medicare pays for the cell gene therapy drug, Encelto, effective for claims with dates of service on or after October 1, 2025, for use in:
- Ambulatory surgical centers (ASCs)
- Hospital outpatient departments: Normal billing rules apply
ASC billing:
- Submit claims the same way as chimeric antigen receptor T-cell therapy. See the Medicare Claims Processing Manual, Chapter 32 (PDF), section 400.2.5.
- Submit multiple claims and append:
- LU modifier (fractionated billing)
- 76 modifier (repeat service or payment by the same physician or other qualified health care professional)
- Use HCPCS code J3403 (revakinagene taroretcel-lwey, per implant).
- Include fractionated units in your claims. For example, if J3403 is $261,579.65:
- If you bill in 0.1 increments, the payment amount will be split out in 10 claims. Submit 9 claims with 0.1 unit and a charge of $26,157.96. Submit 1 additional claim with 0.1 unit and a charge of $26,158.01.
- If you bill in 0.2 increments, the payment amount will be split out in 5 claims. Submit each claim with 0.2 units and a charge of $52,315.93.
- Only bill 1 total unit for J3403 for a single date of service per eye treatment.
HCPCS Application Summaries & Coding Decisions: Non-Drug & Non-Biological Items & Services
CMS published the first biannual 2026 HCPCS application summaries and coding recommendations for non-drug and non-biological items and services. See the HCPCS Level II Coding Decisions webpage for more information.
Events
CCSQ Quarterly Stakeholder Webinar – August 26
Wednesday, August 26 from 11 am – 12 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.
CMS National Provider Enrollment Conference – November 18 & 19
Wednesday, November 18 & Thursday, November 19 in Orlando, Florida
Meet with provider enrollment experts from CMS, Medicare Administrative Contractors, and DME National Provider Enrollment Contractors. Visit the 2026 CMS National Provider Enrollment Conference webpage for more information. Registration opens in mid-September.
MLN Matters® Articles
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (1 of 2)
Learn about updates (PDF), effective January 1, 2027.
Publications & Multimedia
Understanding Telehealth & Teleradiology Enrollment
Not sure how to enroll for telehealth and teleradiology services? Our Understanding Telehealth & Teleradiology Enrollment (PDF) guide breaks down everything you need to know to enroll and bill correctly.
From Our Federal Partners
Risk of Severe Arboviral Disease in Patients Receiving B Cell-Depleting or Modulating Medications
The CDC issued a Health Alert Network Health Advisory to share information and notify clinicians, public health authorities, and the public about the risk of severe arboviral neuroinvasive disease among patients who are receiving B cell-depleting or B cell-modulating medications, particularly anti-CD20 monoclonal antibodies (mAbs). Patients and their providers should be aware of this risk to help patients protect themselves against the bites of mosquitoes and ticks, which can increase patients' risk of arboviral disease.
Read the full Health Advisory, including recommendations for clinicians, health departments, and the public.
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