News
- Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs
- Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Compliance
- Global Surgery: Accurately Report Postoperative Visits
- Optometry Services at Nursing Facilities: Bill Correctly
Events
MLN Matters® Articles
- Hospital Outpatient Prospective Payment System: January 2026 Update
- ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update
- Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease – Revised
- National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension – Revised
News
Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs
If you’re a staff end user (SEU), you can now access Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) through the Identity & Access Management System (I&A). Contact your authorized official (AO) or access manager (AM) and ask them to grant you access.
AOs and AMs – See step-by-step instructions in the I&A System Quick Reference Guide that explain how to:
- Invite and approve an SEU
- Grant PEPPER access to an SEU or Comparative Billing Report business function
More Information:
Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
CMS is improving the Clinical Laboratory Improvement Amendments (CLIA) program by switching to electronic fee coupons and CLIA certificates. After March 1, 2026, paper fee coupons and CLIA certificates will no longer be available; we’ll stop mailing paper versions after this date. In addition, you must pay your CLIA certification and survey fees online; checks will no longer be accepted.
This is the last chance for eligible laboratories and providers that perform laboratory testing to sign up for CMS email notifications to receive electronic CLIA fee coupons and certificates. Failure to switch may result in billing and certification issues.
You can switch to electronic notifications from CMS or update your email address by:
- Emailing your state agency (PDF)
- Contacting your Accreditation Organization if you’re an accredited laboratory
Note: This doesn’t apply to CLIA-exempt states.
Compliance
Global Surgery: Accurately Report Postoperative Visits
In a report, the Office of Inspector General found that although practitioners aren’t required to provide Medicare patients the number of postoperative visits that CMS considered in valuing the global surgery fee, overall, fewer visits are provided than are considered in the valuation.
Practitioners must report post-operative evaluation and management visits if they practice in a group of 10 or more practitioners in 1 of these 9 states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. You’re exempt from required reporting if your practice has less than 10 practitioners, but we encourage you to report if possible.
See the Global Surgery (PDF) booklet for information on how to report postoperative visits in inpatient and outpatient settings.
Optometry Services at Nursing Facilities: Bill Correctly
In a report, the Office of Inspector General found that Medicare improperly paid optometrists for high-level evaluation and management (E/M) services at nursing facilities. These E/M services aren’t usually billed by optometrists and don’t meet Medicare requirements.
Optometrists visit nursing facilities to provide services like:
- Eye exams for residents with diabetes and those at high risk for glaucoma
- Diagnostic tests and treatment for residents with age-related macular degeneration
During the audit, OIG determined that claims didn’t meet the E/M service criteria for moderate to high complexity level subsequent nursing facility care.
Learn how to bill correctly for optometry services at nursing facilities:
- Medicare Vision Services (PDF) booklet
- Items & Services Not Covered Under Medicare (PDF) booklet
- Medicare Preventive Services educational tool
Events
2026 CMS Burden Reduction Conference – February 25
Wednesday, February 25 from 9 am – 1 pm ET
Register today to hear federal government leadership, health provider organizations, and patient-facing clinicians discuss opportunities to reduce administrative burden and strengthen access to quality care across the health care enterprise. In-person attendance has reached capacity, but virtual participation is available.
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: January 2026 Update
Learn about Hospital Outpatient Prospective Payment System (OPPS) updates (PDF), effective January 1, 2026:
- Coding
- Device pass-through status
- Comprehensive ambulatory payment classification
- Drugs, biologicals, and pharmaceuticals
- OPPS Pricer logic
ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update
Learn about updates to National Coverage Determinations (PDF) with new or deleted ICD-10 diagnosis codes, effective July 1, 2026.
Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease – Revised
Learn what’s changed (PDF): CMS removed HCPCS code E0465 and the ICD-10 diagnosis codes; Medicare Administrative Contractors will manage all ICD-10 diagnosis codes locally.
National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension – Revised
Learn what’s changed (PDF):
- Added claims processing instructions for outpatient type of bill 13x
- Added allowable place of service codes 19 and 22 for professional claims
- Specified you may only use CPT code 0935T for professional claims
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