News
- CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines
- CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs
- CMS Proposes Rule to Strengthen Oversight of Organ Procurement Organizations and Protect Patients
- CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy & Sustainability
- DMEPOS Competitive Bidding: Next Round & FAQs
- FY 2025 Medicare Fee-for-Service Improper Payment Rate
- Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Compliance
Claims, Pricers & Codes
Events
MLN Matters® Articles
Publications & Multimedia
From Our Federal Partners
News
CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines
CMS issued an Advance Notice of Proposed Rulemaking (ANPRM) seeking public feedback on potential approaches to strengthen the American-made supply chain for personal protective equipment (PPE) and essential medicines. Building on lessons learned during the COVID-19 public health emergency, the agency is exploring ways to reduce reliance on foreign-made medical supplies and enhance the nation’s readiness for future emergencies while supporting American workers and manufacturers.
The ANPRM seeks comments on new avenues the agency may consider to promote domestic purchasing by hospitals that participate in the Medicare program, including the potential creation of a new “Secure American Medical Supplies” designation for hospitals committed to American-made purchasing, and streamlined payment approaches to help offset the resource costs of domestic procurement.
More Information:
- Full press release
- ANPRM: 60-day comment period
CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs
CMS announced the selection of 15 high-cost prescription drugs covered under Medicare Part D and, for the first time, drugs payable under Medicare Part B for the third cycle of the Medicare Drug Price Negotiation Program. CMS also selected one previously negotiated drug for the program’s first renegotiations. Negotiations with participating drug companies will occur in 2026 and any negotiated and renegotiated prices will become effective January 1, 2028.
More Information:
- Full press release
- Selected Drugs for Initial Price Applicability Year 2028 (PDF) fact sheet
- Top 50 Negotiation-Eligible Drugs for Initial Price Applicability Year 2028 (PDF) fact sheet
- Medicare Drug Price Negotiation Program webpage
CMS Proposes Rule to Strengthen Oversight of Organ Procurement Organizations and Protect Patients
CMS announced a proposed rule to strengthen federal oversight of Organ Procurement Organizations (OPOs). The proposal sharpens the framework for upcoming OPO re-certification cycles and reinforces clear, enforceable standards to protect patients and ensure every viable organ is safely recovered and transplanted.
More Information:
- Full press release
- Fact sheet
- Proposed rule: 60-day comment period
CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy & Sustainability
CMS released the CY 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and MA and Part D Payment Policies (the CY 2027 Advance Notice). This annual release proposes routine and technical updates that ensure MA and Part D payments are accurate. If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09%, or over $700M in MA payments to plans in CY 2027. This expected increase includes consideration of the various elements that impact MA payments, such as growth rates of underlying costs, 2026 Star Ratings for 2027 quality bonus payments, and risk adjustment updates. CMS also expects that the CY 2027 Advance Notice’s proposed policies will promote even greater payment accuracy, maintain beneficiary choice, help ensure affordable coverage for Medicare beneficiaries, and enable an even more stable MA program in the long run.
More Information:
DMEPOS Competitive Bidding: Next Round & FAQs
CMS plans to conduct bidding for the next round of the DMEPOS Competitive Bidding Program (CBP). Read the new FAQs to learn more.
More Information:
- DMEPOS CBP – Updates & Important Information fact sheet
- CY 2026 Home Health Prospective Payment System final rule
FY 2025 Medicare Fee-for-Service Improper Payment Rate
CMS reported the national Medicare Fee-for-Service (FFS) improper payment rate in the FY 2025 HHS Agency Financial Report (section 3, Payment Integrity Report).
The 2025 national Medicare FFS improper payment rate is 6.55%, or $28.83B in improper payments. Most of these improper payments fall into 2 categories:
- Insufficient documentation
- Documentation provided didn’t sufficiently demonstrate medical necessity
See the FY 2025 Improper Payments fact sheet for 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
Pneumatic Compression Devices: Prevent Claim Denials
In 2024, the improper payment rate for pneumatic compression devices was 61.5%, with a projected improper payment amount of $37.7M (see 2024 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Pneumatic Compression Devices & Accessories provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Indications and limitations of coverage
- Documentation requirements
- Example of improper payments due to insufficient documentation
Claims, Pricers & Codes
HCPCS Application Summaries & Coding Determinations: Drugs & Biologicals
CMS published the 2025 HCPCS Application Summary for Quarter 4, 2025 Drugs and Biologicals. Visit the HCPCS Level II Coding Decisions webpage for more information.
Events
Hospital Price Transparency Webinar: Reviewing CY 2026 OPPS & ASC Final Rule Updates – February 11
Wednesday, February 11 from 2–3 pm ET
Join CMS for an overview of the updated hospital price transparency (HPT) requirements that were finalized in the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Learn about:
- Changes to the requirements
- Resources available to hospitals
- Tips for ensuring hospital machine-readable files conform to requirements
All finalized HPT requirements are effective as of January 1, 2026, and CMS will begin enforcing the new and updated requirements on April 1, 2026.
How to Participate:
- Microsoft Teams:
- Meeting ID: 267 631 152 746 64
- Passcode: bH6VH65G
- Phone:
- 888-588-2610
- Conference ID: 997 262 729#
MLN Matters® Articles
Method II Critical Access Hospital: Professional Billing Requirements for Emergency Department Services
Learn about the correct billing requirements (PDF) for Method II critical access hospital providers performing professional emergency department procedures.
Publications & Multimedia
Medicare Billing: CMS-1450 & 837I – Revised
CMS added COVID-19 shots to roster billing (PDF).
Medicare Billing: CMS-1500 & 837P – Revised
CMS added COVID-19 shots to roster billing (PDF).
From Our Federal Partners
New World Screwworm: Outbreak Moves into Northern Mexico
The CDC issued this Health Alert Network Health Advisory to share information and notify clinicians, public health authorities, and the public about recent New World screwworm (NWS) animal cases in the Mexican state of Tamaulipas, which shares a border with the state of Texas.
No NWS infestations related to this outbreak have been identified in people or animals in the United States as of January 20, 2026. However, given the potential for geographic spread, the CDC issued this Health Advisory to increase awareness of the outbreak and to summarize their recommendations for clinicians and health departments in the United States on case identification and reporting, specimen collection, diagnosis, and treatment of NWS, as well as guidance for the public.
See the full Health Advisory for more information, including recommendations for clinicians, health departments, and laboratories.
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).