News
- Long-Term Acute Care Hospitals: Download Your FY 2025 PEPPER
- Clinical Diagnostic Laboratories: Report Your Data Through July 31
Compliance
Claims, Pricers & Codes
MLN Matters® Articles
- Ambulatory Surgical Center Payment System: July 2026 Update
- DMEPOS Fee Schedule: July 2026 Quarterly Update
- Laboratory National Coverage Determination Edit Software: October 2026 Update
News
Long-Term Acute Care Hospitals: Download Your FY 2025 PEPPER
CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Reports (PEPPER) for long-term acute care hospitals. 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
Clinical Diagnostic Laboratories: Report Your Data Through July 31
Are you an independent laboratory, physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS)? If so, you must report your data by July 31, 2026, based on an updated data collection period of January 1 – June 30, 2025, including:
- Applicable HCPCS codes
- Associated private payor rates
- Volume data
How do I report?
- Review CLFS Data Collection System resources:
- Identity Management Registration Guide (PDF)
- Submitter: User manual (PDF) and demo video
- Certifier: User manual (PDF) and demo video
- View the applicable HCPCS codes (ZIP)
- Use the Data Reporting Template (ZIP); see training video
More Information:
- CLFS & PAMA Reporting and Resources webpage
- CLFS: Reporting Private Payor Data (PDF) booklet
- FAQs
- Is My Lab an Applicable Lab? video
Compliance
Hospital Beds & Accessories: Prevent Claim Denials
In 2024, the improper payment rate for hospital beds and accessories was 27.3%, with a projected improper payment amount of $16M. Learn how to bill correctly for these services. Review the Hospital Beds & Accessories provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
- Resources
Claims, Pricers & Codes
Cervical Cancer Screening with HPV Testing: Use the Correct Code
Medicare covers cervical cancer screening with human papillomavirus (HPV) testing for asymptomatic female patients aged 30–65 years once every 5 years as a preventive service. The allowable code to bill Medicare for this screening test is HCPCS code G0476 (Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to Pap test).
More Information:
- Cervical Cancer Screening with HPV Test educational tool
- Screening Pap Tests & Pelvic Exams (PDF) booklet
- National Coverage Determination 210.2.1
MLN Matters® Articles
Ambulatory Surgical Center Payment System: July 2026 Update
Learn about updates (PDF), effective July 1, 2026:
- New Hospital Outpatient Prospective Payment System device pass-through category payable in Ambulatory Surgical Centers (ASCs)
- New HCPCS codes, revised code descriptors, and ASC payment indicator changes for:
- ASC surgical procedures
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitute products
- Non-opioid treatments for pain relief
DMEPOS Fee Schedule: July 2026 Quarterly Update
Learn about guidance (PDF) on continuing to use the KF modifier on claims for HCPCS codes E0747, E0748, and E0760 for dates of service on or after May 18, 2026.
Laboratory National Coverage Determination Edit Software: October 2026 Update
Learn about National Coverage Determinations with added and deleted ICD-10-CM codes (PDF).
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