News
- PEPPER Relaunch for All Facility Types: Get Ready Now
- Clinical Diagnostic Laboratories: Report Your Data Through July 31
- DMEPOS Benefit Category Determinations
Compliance
From Our Federal Partners
News
PEPPER Relaunch for All Facility Types: Get Ready Now
CMS will relaunch the Program for Evaluating Payment Patterns Electronic Report (PEPPER) in the coming months for all Medicare facility types, including hospitals, post-acute care providers, and specialty facilities.
PEPPER is a free tool that helps you review your Medicare billing data so you can identify issues early and support accurate claims. You can use PEPPER to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under‑coded or over‑coded
- Track trends such as longer patient stays
- Take action before problems arise
Act Now: Get Ready to Access Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can access PEPPER through the PEPPER Portal.
How to get access as an SEU:
- Sign in to the CMS Identity & Access (I&A) System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function for 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.
- Once approved, log in to the portal and download your organization’s report.
Take steps now to make sure you have access when we release your facility’s PEPPER:
- See the I&A System Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk for assistance
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
DMEPOS Benefit Category Determinations
CMS updated the Medicare Benefit Policy Manual, Chapter 15 (PDF), Section 110.8 with DMEPOS benefit category determinations.
See the Instruction to your Medicare Administrative Contractor (PDF).
Compliance
Dermatologists: Bill Correctly for Evaluation and Management Services & Minor Surgical Procedures
In a report, the Office of Inspector General found that in 2019 and 2020, approximately 61.5% of Medicare dermatology claims for evaluation and management (E/M) services included a minor surgical procedure on the same day performed by the same dermatologist. These E/M services are generally included in the cost of the minor surgical procedure under Medicare global surgery rules. You should not be paid separately for the E/M component unless a significant, separately identifiable E/M service was performed.
Review the E/M Services (PDF) booklet and learn how to bill correctly:
- Use modifier 25 for a significant and separately identifiable service unrelated to the decision to perform the minor surgical procedure
- Maintain medical record documentation to support the level of service
From Our Federal Partners
Ebola Disease Outbreak in the Democratic Republic of the Congo & Uganda
CDC issued a Health Alert Network Health Advisory to alert clinicians, public health practitioners, and travelers about a new outbreak of Ebola disease in the Democratic Republic of the Congo and Uganda caused by the Bundibugyo virus (species Orthoebolavirus bundibugyoense). The risk of spread to the United States is considered low at this time. As a precaution, this Health Advisory summarizes CDC recommendations for U.S. health departments, clinical laboratories, and health care workers about potential Ebola disease case identification, testing, and biosafety considerations in clinical laboratories.
Read the full Health Update, including recommendations for clinicians.
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