News
Compliance
MLN Matters® Articles
- Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement
- Ambulatory Surgical Center Payment: January 2026 Update
Publications & Multimedia
- Behavioral Health Integration Services — Revised
- Information for Rural Health Clinics — Revised
- Medicare Preventive Services — Revised
News
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
Skilled Nursing Facilities: Accurately Report Your Related Party Costs
In a report, the Office of the Inspector General found that some skilled nursing facilities (SNFs) didn’t comply with Medicare requirements for reporting related party costs. These SNFs failed to report related parties on their Medicare Cost Reports or reported the costs inaccurately, resulting in overstated costs to the Medicare Program.
Review the Skilled Nursing Facility Billing Reference educational tool to find out:
- Why related party costs must be reported accurately
- How to accurately report these costs and required documentation
MLN Matters® Articles
Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement
Learn about updates (PDF), starting July 1, 2026, to billing instructions for ESRD Prospective Payment System (PPS) claims. ESRD facilities:
- Don’t need to submit the AX modifier on claims eligible for certain add-on payment adjustments under the ESRD PPS
- Must adhere to new billing instructions for hemodiafiltration and acute kidney injury claims
Ambulatory Surgical Center Payment: January 2026 Update
Learn about payment system updates (PDF), effective January 1, 2026:
- New device categories, CPT codes, and HCPCS codes
- Drugs and biologicals
- Skin substitutes
- Non-opioid treatments for pain relief
Publications & Multimedia
Behavioral Health Integration Services — Revised
CMS added 3 new optional add-on HCPCS codes (PDF) for general behavioral health integration and psychiatric collaborative care model services when you provide advanced primary care management services.
Information for Rural Health Clinics — Revised
Learn what’s changed (PDF):
- CMS permanently adopted the definition of direct supervision to include supervision through audio-visual telecommunications technology
- We updated the CY 2026:
- Intensive Outpatient Program rates
- Rural health clinic (RHC) all-inclusive rate payment limits
- Telehealth originating site fee
- We added 3 new optional add-on HCPCS codes for behavioral health integration and Psychiatric Collaborative Care Model (CoCM) when you provide advanced primary care management services
- We’re discontinuing the use of:
- HCPCS code G0512 for Psychiatric CoCM services, and we’ll allow RHCs to report codes 99492, 99493, 99494 and G2214 instead
- HCPCS code G0071 for virtual communication services, and we’ll allow RHCs to report codes G2010, G2250, and 98016 instead
- We added a new resource link to the latest telehealth information
- RHCs may continue to bill medical telehealth services using HCPCS code G2025 and serve as a distant site telehealth provider through December 31, 2026
Medicare Preventive Services — Revised
Learn what’s changed:
- Annual wellness visit: Updated description for HCPCS code G0136, effective January 1, 2026
- Medicare Diabetes Prevention Program:
- Added HCPCS code G9871, effective January 1, 2026
- Updated the extended flexibilities period to December 31, 2029
- Updated that sessions can also be held online through December 31, 2029
- Office and outpatient evaluation and management (E/M) visit FAQ: Starting January 1, 2026, you can bill G2211 as an add-on code with the home or residence E/M visits code family
Subscribe to the MLN Connects® newsletter, or read past editions.
View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure.
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).