MLN Connects Newsletter for June 4, 2026

Major reforms were finalized to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution process more efficient and transparent, while also saving money for millions of Americans. The final rule improves the process used to resolve out-of-network payment disputes between providers and payers—cutting administrative costs and improving how disputes are handled.

More Information:

CMS Releases Educational Materials for the Medicare GLP-1 Bridge

CMS released educational materials in support of the Medicare GLP-1 Bridge, which will start on July 1, 2026. Through this short-term demonstration, CMS will be expanding access to certain GLP-1 medications to eligible Medicare Part D beneficiaries who do not currently have access to these medications through the Part D benefit.

CMS published the following materials on CMS.gov:

Prescriber Fact Sheet (PDF): Key information for prescribers referring patients to the Medicare GLP-1 Bridge
Pharmacy Fact Sheet (PDF): Guidance for pharmacies on billing and dispensing under the demonstration
Prior Authorization Form: Outline of clinical criteria for Medicare GLP-1 Bridge eligibility

These materials are intended to support providers and pharmacies, as they prepare for the program's start date and include key details about the prior authorization and pharmacy claims processes. We encourage you to share these resources with your networks and relevant stakeholders. Additional materials, including information intended for people with Medicare, related to the Medicare GLP-1 Bridge will be made available in the coming weeks.

Additionally, we’d like to remind stakeholders that CMS is hosting an informational pharmacy webinar on the Medicare GLP-1 Bridge on Thursday, June 11 from 12 –1 pm ET, via the Zoom webinar platform.

Join the webinar:

Passcode: 616428
Webinar ID: 165 587 6706
Dial in:
- +16692545252,,1655876706# US (San Jose)
- +16468287666,,1655876706# US (New York)

This event will be closed to the public and press. During the webinar, CMS will provide background on the Medicare GLP-1 Bridge and technical instructions designed to help pharmacies fill prescriptions through Medicare GLP-1 Bridge starting July 1, 2026, followed by a live Q&A session.

Hospices: Download Your FY 2025 PEPPER

CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for hospices. 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 Management (I&A) System using your existing NPPES or PECOS credentials
Request the PEPPER business function under your organization
Your request must be approved by your AO or AM

More Information:

Review the User Guide
Register for a webinar on June 24 at 1 pm ET
See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
Contact the External User Services Help Desk

Skilled Nursing Facility Value-Based Purchasing Program: Download Your June 2026 Confidential Feedback Report

Download your June 2026 Quarterly Confidential Feedback Report for the FY 2027 Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) from iQIES. This report provides facility-level measure results for 8 quality measures.

Questions?

Contact iqies@cms.hhs.gov about report access
Contact SNFVBPquestions@cms.hhs.gov about the program

Clinical Diagnostic Laboratory Reporting: Are You an Applicable Lab?

Watch Is My Lab an Applicable Lab? and find out if you meet the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS). If so, you must report your data from May 1 – July 31, 2026.

See the CLFS & PAMA Reporting and Resources webpage for more information.

Hospitals: Accurately Report Allogeneic Hematopoietic Stem Cell Acquisition Costs

If you’re a subsection (d) hospital and you furnish inpatient allogeneic hematopoietic stem cell (Allo-HSC) transplants, you must accurately report Allo-HSC acquisition costs on your Medicare Cost Report:

Use Form CMS-2552-10, Worksheet D-6 from the Provider Reimbursement Manual, Part 2 (PDF)
Only include charges for the recipient and expected recipient (Medicare and non-Medicare) in your hospital
Maintain an itemized statement that identifies all costs defined in 412.113(e)(2)

You must keep records for each patient receiving Allo-HSC acquisition services (donor or recipient). For all donor sources, you must identify the prospective recipient, recipient identifier, and MBI for Medicare patients.

If you perform Allo-HSC acquisition services for another hospital, National Marrow Donor Program, or similar organization, you must seek reimbursement from them. Don’t include the associated Allo-HSC acquisition charges for any organization other than for recipients or expected recipients in your hospital on Worksheet D-6. Medicare only pays for services you furnish to Medicare patients, based on the ratio of Medicare Allo-HSC transplants performed within your hospital to total Allo-HSC transplants performed within your hospital.

More Information:

Medicare Claims Processing Manual, Chapter 3 (PDF), section 90.3.1.A.2
FY 2021 Inpatient Prospective Payment System final rule
Further Consolidated Appropriations Act, 2020, Division N, Title 1, Section 108

Fraud, Waste & Abuse

June 1–5 is Medicare Fraud Prevention Week

Here’s how Americans can help protect themselves and Medicare. June 1 marked the start of Medicare Fraud Prevention Week. While this week shines a spotlight on fraud prevention, protecting Medicare is a year-round mission.

Read the full blog.

Compliance

DME: Complying with Proof of Delivery Requirements

The Comprehensive Error Rate Testing (CERT) Task Force identified missing or incomplete proof of delivery (POD) documents for DME claims. You’re required to maintain POD documentation for 7 years from the date of service regardless of your delivery method.

Use the POD Requirements (PDF) work guide to learn what you must include and what’s required for each delivery method.

More Information:

Standard Documentation Requirements for All Claims Submitted to DME MACs article
Medicare Program Integrity Manual, Chapter 4 (PDF), section 4.7.3.1.1–4.7.3.1.3
CERT webpage

Claims, Pricers & Codes

Medicare Physician Fee Schedule Database: July Update

See the instructions to your Medicare Administrative Contractor (MAC) (PDF) to learn about the July quarterly updates to the Medicare Physician Fee Schedule Database, including:

New codes
Procedure status changes
Short descriptor code revisions
Payment policy indicator changes

Your MAC will give you 30-days notice before they implement these changes. After that, they’ll adjust claims that you bring to their attention.

For more information, see the Medicare Claims Processing Manual, Chapter 23 (PDF), section 30.1.

National Correct Coding Initiative: July Update

Get the National Correct Coding Initiative (NCCI) first quarter edit files effective July 1, 2026, on these Medicare NCCI webpages:

MLN Matters® Articles

ESRD Prospective Payment System: July 2026 Quarterly Update

Learn about changes to the outlier services list (PDF) starting July 1, 2026:

Adding and removing certain renal dialysis items and services
Updating the average unit cost for renal dialysis drugs that are oral equivalents to injectable drugs
Revising the average dispensing fee of the National Drug Codes qualifying for outlier payment to $0.47 per month

ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2026 Update

Learn about updates (PDF) to National Coverage Determinations with new or deleted ICD-10 diagnosis codes, effective October 1, 2026.

Method II Critical Access Hospital: Line-Level Rendering Provider Billing

Learn about updates (PDF):

Critical access hospitals must bill professional services that have rendering NPIs at the line level
Medicare must be able to determine the line-level rendering professional for each outpatient service on a combined billing claim

Rural Health Clinics & Federally Qualified Health Centers: Billing Distant Site Telehealth Services

Rural health clinics and federally qualified health centers must bill the individual CPT or HCPCS code for distant site telehealth services (PDF) they provide instead of HCPCS code G2025, effective October 1, 2026.

Publications & Multimedia

Substance Use Screenings & Treatment – Revised

CMS added HCPCS code G0533 (PDF) to the list of codes to which you can add modifier 59 in some situations.

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).