Proposed Payment Rule
News
- DMEPOS Competitive Bidding Program: Get Licensed & Accredited for Round 2028
- Inpatient Rehabilitation Facility: Download Your FY 2025 PEPPER
- PECOS: Protect Your Application
Compliance
Claims, Pricers & Codes
MLN Matters® Articles
- HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update
- Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology
Publications & Multimedia
From Our Federal Partners
- Domestically Acquired Cyclosporiasis Cases in Multiple U.S. States
- VA Payments: Enroll in Direct Deposit
Proposed Payment Rule
CY 2027 Medicare Physician Fee Schedule Proposed Rule
CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2027.
The proposed rule also includes:
- CY 2027 PFS rate setting and conversion factor
- Strengthening Medicare ACO participation and accountability
- Medicare Shared Savings Program requirements
- Quality Payment Program proposals and requests for information (RFIs)
- Evaluation and management (E/M) visits:
- Accounting for overlap between stand-alone E/M visits and global periods
- Complexity add-on code
- Remote monitoring
- Comment solicitation on:
- Redesigning primary care to make America healthy again
- Strategies for improving global surgery payment accuracy
- Policies to improve care for chronic illness and behavioral health needs
- Clinical Laboratory Fee Schedule payment and reporting requirements
- Medicare Prescription Drug Inflation Rebate Program
- Limiting Medicare coverage of certain individuals
- RFI on duplicate laboratory testing, imaging, and result sharing and interoperability
More Information:
- Full fact sheet
- CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment & Shift from Sick Care to Healthcare press release
- Medicare Shared Savings Proposals fact sheet
- Quality Payment Program fact sheet and policy comparison table
News
DMEPOS Competitive Bidding Program: Get Licensed & Accredited for Round 2028
On November 28, 2025, CMS announced plans for Round 2028 of the DMEPOS Competitive Bidding Program. If you plan to bid, you should prepare now. Read the news article to learn how to:
- Get licensed and accredited
- Stay informed
Inpatient Rehabilitation Facility: Download Your FY 2025 PEPPER
CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for inpatient rehabilitation facilities. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it to:
- Spot billing patterns that may need improvement
- Identify areas that may need audits or closer monitoring
- Find diagnosis-related groups that may be under-coded or over-coded
- Track areas where patient stays are getting longer
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) Management System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function under your organization. The Comparative Billing Report business function is also available and can be requested at the same time.
- Your AO or AM must approve your request.
More Information:
- Visit the Training & Resources webpage for more information about the release and the User Guide
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
PECOS: Protect Your Application
Did you know that PECOS will automatically delete inactive enrollment applications? See the PECOS Inactivity Deletion Policy (PDF) to understand key timelines and best practices to keep your enrollment on track—don't let your hard work disappear.
Compliance
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
Claims, Pricers & Codes
Screening for Hepatitis C Virus in Adults National Coverage Determination: Using HCPCS Code G0567
CMS updated Medicare Claims Processing Manual, Chapter 18 (PDF), sections 210–210.4 to add HCPCS code G0567, payable with or without modifier QW, effective June 27, 2024.
See the instruction to your Medicare Administrative Contractor (PDF).
MLN Matters® Articles
HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update
Learn about the 19 new HCPCS codes (PDF) CMS is adding to the non-routine supply code list, effective October 1, 2026.
Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology
Learn about using a modifier or G code (PDF), starting January 1, 2027.
Publications & Multimedia
Medicare Fraud & Abuse: 2 Updated Resources
Learn how to prevent, detect, and report Medicare fraud and abuse:
From Our Federal Partners
Domestically Acquired Cyclosporiasis Cases in Multiple U.S. States
CDC is notifying clinicians, public health practitioners, and laboratorians of cases of domestically acquired cyclosporiasis in multiple U.S. states. Since May 1, 2026, CDC has received reports of 1,645 confirmed domestic cases of cyclosporiasis and is aware of more than 5,100 cases that require further analysis to confirm the illness as domestically acquired cyclosporiasis. This is substantially higher than the 249 cases reported nationally by this same time last year. Of the 1,645 case-patients with available information, 141 (9%) were hospitalized, and none have died. CDC, FDA, and state and local health departments are working together to investigate multistate outbreaks of Cyclospora infections and to identify the sources of illness. Because cyclosporiasis is often underdiagnosed and underreported, the true number of illnesses is likely higher than what has been reported to CDC.
Read the full Health Advisory for information on disinfecting Cyclospora in health care settings and recommendations for:
- Clinicians
- Laboratories
- Health departments
- The public
VA Payments: Enroll in Direct Deposit
Veterans Affairs (VA) requires all community care providers to receive payment through direct deposit (electronic funds transfer). This includes those billing Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and other VA programs.
Providers must enroll in direct deposit or update existing banking information using VA Form 10091 through the VA‑FSC Customer Engagement Portal. For instructions, see the Vendor Webform User Guide.
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