News
Claims, Pricers & Codes
- Rural Health Clinic & Federal Qualified Health Center: Adjusting Claims for Care Coordination Services
- HCPCS Application Summaries & Coding Determinations: Non-Drug & Non-Biological Items and Services
MLN Matters® Articles
- Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease
- ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2026 Update
- National Coverage Determination 20.38: Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation
Publications & Multimedia
News
HHS Drives Reform to Restore Patient-Centered Care, Announces Request for Nominations of Members to Serve on Federal Healthcare Advisory Committee
HHS and CMS are establishing the Healthcare Advisory Committee—a group of experts charged with delivering strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz to improve how care is financed and delivered across Medicare, Medicaid and the Children's Health Insurance Program, and the Health Insurance Marketplace.
Read the full press release.
Claims, Pricers & Codes
Rural Health Clinic & Federal Qualified Health Center: Adjusting Claims for Care Coordination Services
CMS is aware that certain claims for Rural Health Clinic and Federal Qualified Health Center care coordination services were incorrectly paid the national Physician Fee Schedule non-facility payment rate, adjusted for geographic differences. These services shouldn’t be geographically adjusted.
Medicare Administrative Contractors will adjust claims for these services with dates of service on or after January 1, 2025:
- Type of bill: 71X or 77X
- HCPCS code: 98975, 98976, 98977, 98980, 98981, 99091, 99424, 99425, 99426, 99427, 99437, 99439, 99453, 99454, 99457, 99458, 99474, 99484, 99487, 99489, 99490, 99491, G0019, G0022, G0023, G0024, G0140, G0146, G0323, G0511, G0556, G0557, G0558, G3002, or G3003
You don’t need to take any action.
HCPCS Application Summaries & Coding Determinations: Non-Drug & Non-Biological Items and Services
CMS published the first biannual 2025 HCPCS Level II coding, Medicare benefit category, and Medicare payment determinations for non-drug and non-biological items and services. Visit the HCPCS Level II Coding Decisions webpage for more information.
MLN Matters® Articles
Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease
Learn about updates (PDF) effective June 9, 2025, including updated Medicare coverage guidance for:
- Respiratory assistance devices
- Home mechanical ventilators
Your Medicare Administrative Contractor will adjust claims you bring to their attention.
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2026 Update
Learn about new or deleted ICD-10 diagnosis codes effective January 1, 2026. See update 1 of 2 (PDF) and 2 of 2 (PDF).
National Coverage Determination 20.38: Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation
Learn about national coverage (PDF) of transcatheter edge-to-edge repair for tricuspid valve regurgitation (T-TEER):
- Criteria
- Coverage with evidence development study criteria
- Claims processing requirements
Publications & Multimedia
A Prescriber’s Guide to Medicare Prescription Drug (Part D) Opioid Policies — Revised
Learn what’s changed (PDF):
- CMS clarified that:
- Part D plans have 3 days to send the second notice when implementing a coverage limitation
- Medication-assisted treatment is also known as medications for opioid use disorder
- We added information on Opioid Treatment Programs
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