News
- Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details
- ACCESS Model Expands Access to Technology-Supported Care in Original Medicare
- Clinical Laboratory Fee Schedule: CY 2026 Final Payment Determinations
- Chronic Care Management: Learn About Services for Complex Conditions
Compliance
Claims, Pricers & Codes
Events
MLN Matters® Articles
News
Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details
An April 15 Executive Order requires the HHS Secretary to conduct a survey under section 1833(t)(14)(D)(ii) of the Social Security Act to determine the hospital acquisition cost for covered outpatient drugs at hospital outpatient departments. On November 25, the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule established the OPPS Drug Acquisition Cost Survey (ODACS).
CMS will conduct the survey from January 1 – March 31, 2026, via the Fee-for-Service Data Collection System. The purpose of the survey is to gather accurate drug acquisition costs for select covered outpatient drugs and biological products purchased by hospitals paid under the Medicare Hospital OPPS. We intend to use survey results to inform policymaking starting with the CY 2027 OPPS and ASC proposed rule.
Hospitals that received OPPS payments for outpatient drugs from July 1, 2024 – June 30, 2025, must complete the survey and report data on all payable outpatient drugs purchased during this period. If you haven’t confirmed your Point of Contact for this initiative, email OPPSDrugSurvey@cms.hhs.gov as soon as possible and include your hospital's CMS Certification Number.
ODACS registration starts this December. Visit the ODACS webpage to prepare for registration:
- Attend training webinars on December 9 and 11
- Review resources and instructions to learn about the survey system and requirements
ACCESS Model Expands Access to Technology-Supported Care in Original Medicare
What’s New
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model tests an outcome-aligned payment approach designed to give people with Original Medicare new options to improve their health and prevent and manage chronic disease with technology-supported care. The voluntary model focuses on common conditions, such as high blood pressure, diabetes, chronic musculosketal pain, depression, and other conditions affecting millions of Americans.
Why It Matters
Today, people with Original Medicare have limited access to modern, technology-supported care for managing their chronic conditions.
What to Expect
CMS will begin accepting applications for the 10-year voluntary model on January 12, 2026, with an initial deadline of April 1, 2026. ACCESS will begin July 1, 2026. The Request for Applications will be available soon; the ACCESS Model Interest Form can be completed to be notified when the application becomes available.
Visit the ACCESS Model webpage for more information.
Clinical Laboratory Fee Schedule: CY 2026 Final Payment Determinations
Get final CY 2026 payment information for the Clinical Laboratory Fee Schedule (CLFS):
- Payment determinations (ZIP): Submit reconsideration requests by January 26 to CLFS_Annual_Public_Meeting@cms.hhs.gov to discuss at next year’s meeting
- Gapfill rates (ZIP)
Visit the CLFS Annual Public Meetings webpage for more information on the annual rate setting process.
Chronic Care Management: Learn About Services for Complex Conditions
Medicare covers chronic care management (CCM), which is managing a patient’s multiple (2 or more) chronic conditions expected to last at least 12 months, or until their death. We cover CCM and other management services for some patients with complex conditions. Visit the Chronic Care Management for Complex Conditions webpage to learn more, including:
- Who’s eligible?
- What’s my role?
- How do I get started?
- How do I bill?
Compliance
DME: Complying with Proof of Delivery Requirements
The Comprehensive Error Rate Testing (CERT) Task Force identified missing or incomplete proof of delivery (POD) documents for DME claims. You’re required to maintain POD documentation for 7 years from the date of service regardless of your delivery method.
Use the CERT DME POD Requirements (PDF) work guide to learn what you must include and what’s required for each delivery method.
More Information:
- Standard Documentation Requirements for All Claims Submitted to DME MACs article
- Medicare Program Integrity Manual, Chapter 4 (PDF), section 4.7.3.1.1–4.7.3.1.3
- CERT webpage
Claims, Pricers & Codes
Hospice Claims Billed by Terminated Hospices
CMS updated the Medicare Claims Processing Manual, Chapter 11 (PDF), adding section 110 with payment procedures for terminated hospices. See the instruction to your Medicare Administrative Contractor (PDF) for more information.
Integrated Outpatient Code Editor Version 26.3
CMS posted the October 2025 Integrated Outpatient Code Editor files. Learn about claims processing changes effective October 1, 2025.
See the instruction to your Medicare Administrative Contractor (PDF).
Events
HCPCS Public Meeting — December 17–18
Wednesday, December 17 and Thursday, December 18, from 9 am – 5 pm ET
Attend the virtual public meeting for the second biannual 2025 HCPCS Level II coding cycle. Visit the HCPCS Level II Public Meetings webpage for more information, including:
- Meeting materials
- Guidelines
MLN Matters® Articles
Therapy Code List: 2026 Annual Update
Learn about updates (PDF), effective January 1, 2026, for remote therapeutic monitoring services designated as sometimes therapy:
- New codes
- Revised code descriptors
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