News
- CMS Announces Manufacturer Participation in Third Cycle of Medicare Drug Price Negotiation
- Quality Payment Program: Medicare Shared Savings Program ACOs Must Submit Quality Data by March 31
- Hospitals: Apply for Additional Residency Positions by March 31
- Hospitals: It’s Not Too Late to Submit Data for OPPS Drug Acquisition Cost Survey
- Short-Term Acute Care Hospitals: Download Your Quarter 4 FY 2025 PEPPER
- Medicare Shared Savings Program: Application Deadlines for January 1, 2027, Start Date
- ESRD Prospective Payment System: Furnishing Drugs & Biological Products Included in Bundled Payment
- Advance Beneficiary Notice of Noncoverage: Updated Form
- Important Message from Medicare & Detailed Notice of Discharge: Updated Forms
Claims, Pricers & Codes
Events
MLN Matters® Articles
- Cardiac Contractility Modulation for Heart Failure – Revised
- ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2026 Update – Revised
Publications & Multimedia
News
CMS Announces Manufacturer Participation in Third Cycle of Medicare Drug Price Negotiation
Under the Medicare Drug Price Negotiation Program (“Negotiation Program”), CMS directly negotiates the prices of certain high expenditure, single source drugs without generic or biosimilar competition. CMS announced that the drug companies that manufacture the 15 drugs (PDF) payable under Medicare Part B and/or covered under Medicare Part D selected for the third cycle of negotiations in the Negotiation Program have chosen to participate in the Negotiation Program.
Read the full fact sheet.
Quality Payment Program: Medicare Shared Savings Program ACOs Must Submit Quality Data by March 31
The data submission period for performance year 2025 of the Quality Payment Program ends on March 31, 2026, at 8 pm ET. Medicare Shared Savings Program Accountable Care Organizations (ACOs) should review their quality data for completeness and accuracy and submit by the deadline. Your data can’t be updated or corrected after the submission period closes. See the 2025 Alternative Payment Model Performance Pathway Data Submission User Guide for a comprehensive walk-through.
If you have any issues, contact the Quality Payment Program at 866-288-8292 or QPP@cms.hhs.gov.
Hospitals: Apply for Additional Residency Positions by March 31
Apply for additional residency positions under section 126 of the Consolidated Appropriations Act, 2021 by March 31, 2026. Visit the Direct Graduate Medical Education webpage for information on Round 5:
Hospitals: It’s Not Too Late to Submit Data for OPPS Drug Acquisition Cost Survey
The Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey (ODACS) is live. Hospitals paid under OPPS and listed on this ODACS provider table (PDF) must submit their drug acquisition cost data to CMS by March 31, 2026, at 11:59 pm ET.
To complete the survey, you must:
- Follow the steps in the Registration User Guide (PDF) to register for the online system
- Upload your drug acquisition cost data using this template (ZIP)
- Follow the steps in the Submitter User Guide (PDF) to complete the online attestation form
- Submit your data by March 31
More Information:
- Visit the ODACS webpage for official guidance on the survey
- Read FAQs (PDF)
- Contact OPPSDrugSurvey@cms.hhs.gov with questions
Short-Term Acute Care Hospitals: Download Your Quarter 4 FY 2025 PEPPER
CMS released Quarter 4 FY 2025 Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) for short-term acute care hospitals. PEPPER helps hospitals review their billing data to make sure claims are accurate. They can 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 (SEU) can download their organization’s report from the PEPPER Portal:
- AOs and AMs: Grant SEUs the PEPPER business function in the Identity & Access Management System
- SEUs: Work with your AO or AM to get access to the PEPPER Portal
More Information:
- Review the User Guide
- Register for the webinar on April 7 at 1 pm ET
Medicare Shared Savings Program: Application Deadlines for January 1, 2027, Start Date
Accountable Care Organizations (ACOs): See the Medicare Shared Savings Program Application Types & Timeline webpage to learn about key dates for a January 1, 2027, start date. CMS will accept applications starting June 9 through the ACO Management System. Apply no later than June 23 at noon ET.
ESRD Prospective Payment System: Furnishing Drugs & Biological Products Included in Bundled Payment
CMS doesn’t prescribe a specific operational or distribution model for drugs and biological products included in the ESRD Prospective Payment System (PPS) bundled payment. They may be furnished through a variety of arrangements involving different entities, such as pharmacies, including independent pharmacies.
See Overview of Existing Medicare Policy Related to Drugs & Biological Products Under the ESRD PPS (PDF) for more information.
Advance Beneficiary Notice of Noncoverage: Updated Form
The Office of Management and Budget approved the updated Advance Beneficiary Notice of Noncoverage (Form CMS-R-131). It’s available in English and Spanish. CMS improved the readability and design.
You may use the updated form now, but you must use it starting May 12, 2026, when the previous version expires.
Important Message from Medicare & Detailed Notice of Discharge: Updated Forms
The Office of Management and Budget approved the updated:
- Important Message from Medicare (Form CMS-10065)
- Detailed Notice of Discharge (Form CMS-10066)
They’re available in English and Spanish on the Beneficiary Notices Initiative webpage. You may use the updated forms now, but you must use them starting May 15, 2026, when the previous version expires.
For more information about the forms, see the Medicare Claims Processing Manual, Chapter 30 (PDF), section 200.
Claims, Pricers & Codes
Inpatient Psychiatric Facilities Prospective Payment System: April 2026 Coding Updates
See the instruction to your Medicare Administrative Contractor (PDF) for ICD-10 code updates to procedures lists, effective April 1, 2026:
- Oncology Treatment
- Chronic Obstructive Pulmonary Disease & Sleep Apnea
Events
Average Sales Price Data Collection System Training Webinar – April 14
Tuesday, April 14 from 1–2 pm ET
Register for the webinar.
Medicare Part B drug manufacturers: Join CMS for a webinar highlighting the newest average sales price (ASP) Data Collection System features and recent changes, including bona fide service fees and reasonable assumption forms. Panelists will also address data entry questions related to the quarterly submission process.
More Information:
- Visit the ASP webpage for more information.
- Send your questions in advance to sec303aspdata@cms.hhs.gov with “ASP Data Collection System Training” in the subject line
MLN Matters® Articles
Cardiac Contractility Modulation for Heart Failure – Revised
CMS added 4 additional place of service codes (PDF) for professional claims processing.
ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2026 Update – Revised
CMS added a link (PDF) to the Medicare Claims Processing Manual update.
Publications & Multimedia
Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance – Revised
CMS added more information (PDF) on what type of insulin and insulin pumps we cover under Medicare Part B.
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