MLN Connects Newsletter for January 22, 2026

If CMS selects these items for face-to-face encounter, written order prior to delivery, or prior authorization, you may be required to do one or both:

Meet with your patient and give them a written order before delivering the item
Ask your Medicare Administrative Contractor to authorize the item in advance

More Information:

Required Face-to-Face Encounter and Written Order Prior to Delivery List (PDF): Added 8 new oxygen items
Required Prior Authorization List (PDF): Added 5 new orthoses and 2 pneumatic compression device items
Standard Elements for DMEPOS Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements (PDF) MLN Matters® article

Compliance

Evaluation and Management Services & Intravitreal Injections: Bill Correctly

In a report, the Office of the Inspector General found that Medicare providers improperly billed for evaluation and management (E/M) services provided on the same day as intravitreal injections using modifier 25. Only a significant and separately identifiable E/M service unrelated to the decision to perform the minor surgical procedure should be separately reported with modifier 25.

Learn when to use modifier 25 to prevent improper payments:

E/M Services (PDF) booklet
Medicare Vision Services (PDF) booklet

Claims, Pricers & Codes

Vagus Nerve Stimulation National Coverage Determination: Removing National Edit for Diagnosis Code G47.33

CMS incorrectly added ICD-10 diagnosis code G47.33 (Obstructive Sleep Apnea) as a covered indication for CPT code 64568 under National Coverage Determination (NCD) 160.18. This NCD is specific to vagus nerve stimulation for medically refractory partial onset seizures for whom surgery is not recommended or for whom surgery has failed and treatment-resistant depression. It is unrelated to obstructive sleep apnea; coverage of this diagnosis code falls under your Medicare Administrative Contractor’s (MAC’s) discretion and isn’t mandated by the NCD.

Your MAC will adjust affected claims.

Events

CCSQ Quarterly Stakeholder Webinar – February 4

Wednesday, February 4 from 3–4 pm ET

You’re invited to join Dr. Dora Hughes, Chief Medical Officer of CMS and Director of the Center for Clinical Standards and Quality (CCSQ), and the CCSQ leadership team for an engaging update on our work to strengthen health care quality, safety, and coverage. Hear the latest on recent policy developments and how these efforts are accelerating progress toward improving care and outcomes for beneficiaries in Medicare, Medicaid, and the Marketplace.

Publications & Multimedia

Medicare Wellness Visits — New Webpage

Medicare Wellness Visits is now a CMS.gov webpage. We’re changing some Medicare Learning Network® products to webpages to improve user experience and content accessibility.

Telehealth & Remote Monitoring – Revised

Learn what’s changed:

CMS added a resource link for the latest telehealth information
We added information on how to suppress a practitioner’s home address in PECOS
We removed telehealth frequency limitations for subsequent inpatient and nursing facility, and critical care consultations
We’ll permanently allow teaching and supervising physicians to supervise through virtual presence
We’ll continue to pay Rural Health Clinics and Federally Qualified Health Centers for medical telehealth services through December 31, 2026
Starting in CY 2026, we’ll only add services to the Medicare telehealth services list on a permanent basis
We added 5 new CPT and HCPCS codes to the Medicare telehealth services list
For CY 2026, we updated the:
- Medicare Economic Index
- Originating site fee

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).