MLN Connects Newsletter for August 7, 2025

CMS is improving the Clinical Laboratory Improvement Amendments (CLIA) program by switching to electronic fee coupons and CLIA certificates. To continue getting these, eligible laboratories and providers that perform laboratory testing must switch to electronic email notifications by March 1, 2026; we’ll stop mailing paper versions after this date.

There are 3 ways to switch:

Email your state agency (PDF)
Contact your Accreditation Organization if you’re an accredited laboratory
Fill out the CLIA Application for Certification (PDF) (form CMS-116), and check the box next to “Receive notifications including electronic certificates via email” in section I

Note: This doesn’t apply to CLIA-exempt states.

Improve Your Search Results for CMS Content

If you’re using a search engine to find information on CMS.gov, include “CMS” in your search term to get the best results. If you recently visited a CMS webpage, you may need to refresh your browser to see the latest content.

Fraud, Waste & Abuse

Crushing Fraud

Help CMS fight fraud, waste, and abuse. Take a look at our updated Crushing Fraud, Waste & Abuse webpage for the latest information, including:

Urgent fraud scheme alerts
Recent successes
Fast facts
How to report

Compliance

Evaluation & Management Services: Prevent Claim Denials

In 2023, the improper payment rate for evaluation and management codes was 10.7%, with a projected improper payment amount of $3.7 billion (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Evaluation & Management Services provider compliance tip for more information, including:

Denial reasons and how to prevent them
Coding
Resources

Claims, Pricers & Codes

Ambulance Claims: Revised July ZIP Code Files

CMS identified an issue with the July ZIP Code file and ambulance claims. We issued revised files on July 29. Your Medicare Administrative Contractor will automatically reprocess affected claims. You don’t need to take any action.

Skilled Nursing Facility Prospective Payment System: FY 2025 Pricer Update

CMS published payment rates effective October 1, 2025, in the FY 2026 Skilled Nursing Facility (SNF) final rule.

Effective FY 2023, CMS won’t reduce SNF final wage indexes by more than 5% compared to the prior FY. This doesn’t apply to new SNFs that open in FY 2026 because they didn’t have a prior wage index.

More Information:

Events

CMS Listening Session: Opportunities to Enhance Real-Time Claims Processing & EDI Cybersecurity Controls — August 13

Wednesday, August 13 from 3–4 pm ET

As part of CMS’ 2025 priorities, we’re holding a listening session to gather feedback from our industry partners for innovative ideas and opportunities for real-time claims processing. We’re also looking to improve Medicare’s Electronic Data Interchange (EDI) cybersecurity controls that support the security and integrity of electronic transactions physicians, suppliers, and other providers use to submit Medicare Part A and Part B claims.

We’re interested in getting your feedback based on your experiences with other insurers with real-time claims processing integration and solutions in the industry (such as revenue cycle health, denials, rejections, appeals, reimbursement time frames).

We also want to hear your feedback to improve and enhance our processes related to strengthening Medicare’s EDI cybersecurity controls to better protect the integrity and availability of information systems involved in processing Medicare claims and the security and privacy of the sensitive beneficiary data being exchanged.

Email comments or questions in advance of the listening session to cmslistens@cms.hhs.gov with “Real-Time Claims & EDI Cybersecurity” in the subject line. We may address them during the listening session or use them to develop other resources following the session.

Read the full announcement (PDF) for more information.

MLN Matters® Articles

Billing the Laboratory Specimen Collection Travel Allowance to the 10th of a Mile

Learn about changes effective January 1, 2026 (PDF), allowing you to bill HCPCS code P9603 calculated to the 10th of a mile:

How to properly bill
When to bill using a whole number of miles

National Coverage Determination 20.37: Transcatheter Tricuspid Valve Replacement

Learn about national coverage (PDF) of transcatheter tricuspid valve replacement:

Criteria
Coverage with evidence development study criteria
Claims processing requirements

Ambulatory Surgical Center Payment System: July 025 Update — Revised

CMS revised this article (PDF) to update the number of new HCPCS codes and coding information in the drugs, biologicals, and radiopharmaceuticals section.

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