News
- CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements
- CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice & Home Health Agency Enrollment Moratoria
- Clinical Diagnostic Laboratories: Report Your Data Through July 31
- Care Compare: CY 2024 Doctors & Clinicians Preview Period Open until June 11
- CMS Identifies Participants in Mandatory Ambulatory Specialty Model
- National Mental Health Awareness Month
Compliance
Claims, Pricers & Codes
MLN Matters® Articles
From Our Federal Partners
News
CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements
CMS, through its Health Tech Ecosystem, is advancing its electronic prior authorization efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements.
30 healthcare organizations—including health systems, electronic health record developers, physician practices, networks, and digital health developers—have signed on as early adopters in this cross-sector effort. They join many of the nation’s largest payers that have already committed to working with CMS to identify and address workflow, technical, and operational barriers that have slowed adoption of electronic prior authorization across the healthcare system.
Read the full press release.
CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice & Home Health Agency Enrollment Moratoria
In coordination with Vice President JD Vance’s Anti-Fraud Task Force, CMS is taking decisive action to protect Medicare beneficiaries and taxpayer dollars through implementation of a six-month, nationwide data-driven moratoria on new Medicare enrollment for hospices and home health agencies (HHAs). The moratoria will allow CMS to temporarily halt the influx of new providers into these high-risk categories—a key source of fraudulent activity.
More information:
- Full press release
- Nationwide Temporary Moratorium on Enrollment of Hospices notice
- Nationwide Temporary Moratoria on Enrollment of HHAs notice
- Crushing Fraud, Waste, & Abuse webpage
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
Care Compare: CY 2024 Doctors & Clinicians Preview Period Open until June 11
The CY 2024 Doctors and Clinicians Preview Period is open until Thursday, June 11, 2026, at 8 pm ET. Securely preview your CY 2024 Quality Payment Program performance information before it appears in the Provider Data Catalog and on clinician and group profile pages on the Medicare.gov compare tool.
For more information, visit the Care Compare: Doctors and Clinicians Initiative webpage.
CMS Identifies Participants in Mandatory Ambulatory Specialty Model
CMS published the preliminary participant list for the mandatory Ambulatory Specialty Model (ASM) for the 2027 performance year. If you’re a specialist who frequently treats people with Original Medicare for low back pain or heart failure in an outpatient setting, visit the ASM Participants webpage to see if you’re on the list. We’ll adjust ASM participants’ future Part B payments based on their performance on reported measures and activities.
More Information:
National Mental Health Awareness Month
During National Mental Health Awareness Month, we recognize the millions of Americans affected by mental health challenges. Good mental health is a component of healthy aging and essential to a high quality of life for all ages (SAMHSA). Recommend appropriate Medicare Preventive Services.
Medicare covers preventive services, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services (PDF). If you need help, contact your eligibility service provider.
More Information:
- Medicare & Mental Health Coverage (PDF) booklet
- Behavioral Health Integration Services (PDF) booklet
- CMS Behavioral Health Strategy
- Preventive & screening services information for your patients
Compliance
Remote Patient Monitoring: Use & Bill Correctly
In a report, the Office of Inspector General recommended additional oversight of remote patient monitoring in Medicare. About 43% of enrollees who received remote patient monitoring didn’t receive all 3 components, raising questions about whether it’s being used as intended.
Learn how to correctly use and bill for remote patient monitoring:
- Remote Patient Monitoring webpage
- Telehealth & Remote Monitoring booklet
Suction Pumps: Prevent Claim Denials
In 2024, the improper payment rate for suction pumps was 33.5%, with a projected improper payment amount of $4.7M. Learn how to bill correctly for these services. Review the Suction Pumps provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
Claims, Pricers & Codes
Bone Growth Stimulators Reclassified as Class II Devices: Get Updated Billing Information
The FDA issued a final order to reclassify non-invasive bone growth stimulators (also known as osteogenesis stimulators) from class III devices to class II devices. Effective May 18, 2026, the following HCPCS codes will describe only class II devices:
- E0747 Osteogenesis Stimulator, Electrical, Non-Invasive, Other than Spinal Applications
- E0748 Osteogenesis Stimulator, Electrical, Non-Invasive, Spinal Applications
- E0760 Osteogenesis Stimulator, Low Intensity Ultrasound, Non-Invasive
Starting with dates of service on or after May 18, claims for these HCPCS codes must be billed without the KF modifier.
CMS will update the fee schedule amounts for these codes to reflect the change from class III to class II starting with dates of service on or after May 18. The July 2026 DMEPOS fee schedule update will include the recalculated fees.
MLN Matters® Articles
Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement – Revised
CMS added HCPCS code G0491 (PDF) to the billing requirements for acute kidney injury hemodiafiltration claims.
From Our Federal Partners
2026 Multi-country Hantavirus Cluster Linked to Cruise Ship
On May 11, 2026, the CDC issued this Health Alert Network Health Advisory to inform clinicians and health departments about a new cluster of hantavirus disease cases caused by infection with Andes virus. Hantavirus disease can cause severe illness and can be fatal. Clinicians should be aware of the potential for imported cases, although the risk of broad spread to the United States is considered extremely unlikely at this time. As a precaution, this Health Advisory summarizes CDC's recommendations for U.S. public health departments, clinical laboratories, and healthcare workers about hantavirus disease case identification, testing, and biosafety considerations in clinical laboratories.
Read the full Health Advisory.
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).