News
- Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate
- Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Compliance
- Intermittent Urinary Catheters: Medicare Improperly Paid Suppliers
- Surgical Dressings: Prevent Claim Denials
Claims, Pricers & Codes
News
Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate
The CY 2026 historically excepted (previously called grandfathered) tribal Federally Qualified Health Center Prospective Payment System rate is $733 for medically necessary face-to-face visits.
CMS will adjust CY 2026 claims paid at the CY 2025 rate. You don’t need to take any action.
See the instruction to your Medicare Administrative Contractor (PDF).
Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
The Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (ODACS) is live. Hospitals paid under OPPS and listed on this ODACS provider table (PDF) must submit their drug acquisition cost data to CMS by March 31 at 11:59 pm ET.
More Information:
- Visit the ODACS webpage for official guidance on the survey
- Read FAQs (PDF)
- Contact OPPSDrugSurvey@cms.hhs.gov with questions
Compliance
Intermittent Urinary Catheters: Medicare Improperly Paid Suppliers
In a report, the Office of Inspector General found that Medicare improperly paid for catheters and kits. To avoid improper payments, review the Urological Supplies provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
- Resources
Surgical Dressings: Prevent Claim Denials
In 2024, the improper payment rate for surgical dressings was 57.6%, with a projected improper payment amount of $177M (see 2024 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Surgical Dressings provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
- Example of improper payments due to insufficient documentation
- Resources
Claims, Pricers & Codes
Home Health Prospective Payment System Grouper: April Update
Get the April 2026 release (Version 07.1.26 (ZIP)). See the Home Health Prospective Payment System Grouper Software webpage for a summary of changes.
More Information:
- Claims Processing Manual, Chapter 10 (PDF), section 80
- Instruction to your Medicare Administrative Contractor (PDF)
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