News
- 2026 Medicare Parts A & B Premiums and Deductibles
- All 50 States Seek to Transform Rural Health with CMS
- CMS Releases Final Guidance for Initial Price Applicability Year 2028
- Information for Critical Access Hospitals
- Laboratories: Switch to Electronic Fee Coupons & CLIA Certificates
- Lung Cancer: Help Your Patients Reduce Their Risk
Compliance
- Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters
- Parenteral Nutrition: Prevent Claim Denials
MLN Matters® Articles
- Ambulatory Surgical Center Payment System: October 2025 Update
- Hospital Outpatient Prospective Payment System: October 2025 Update
- New Waived Tests
- DMEPOS Fee Schedule: October 2025 Quarterly Update — Revised
Publications & Multimedia
Information for Patients
News
2026 Medicare Parts A & B Premiums and Deductibles
On November 14, CMS released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D income-related monthly adjustment amounts.
Medicare Part A Inpatient Hospital
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,736 in 2026, an increase of $60 from $1,676 in 2025. Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2026, beneficiaries must pay a coinsurance amount of $434 per day for the 61st through 90th day of a hospitalization ($419 in 2025) in a benefit period and $868 per day for lifetime reserve days ($838 in 2025).
Skilled Nursing Facility
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $217.00 in 2026 ($209.50 in 2025).
Medicare Part B
The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Read the full fact sheet for more information.
All 50 States Seek to Transform Rural Health with CMS
CMS announced that all 50 states submitted applications for the $50 billion Rural Health Transformation Program—a landmark initiative created under the Working Families Tax Cuts legislation to strengthen health care across rural America.
Read the full press release.
CMS Releases Final Guidance for Initial Price Applicability Year 2028
Final guidance addresses how drugs payable under Medicare Part B will be eligible for negotiation, requirements and process for renegotiation
CMS released final guidance for the third cycle of negotiations under the Medicare Drug Price Negotiation Program. This final guidance incorporates significant policy refinements based on public feedback, with a particular focus on increasing transparency, and implements expanded protections for orphan drugs enacted in the Working Families Tax Cuts Act (Public Law 119-21).
More information:
Information for Critical Access Hospitals
The critical access hospital (CAH) bills for facility and professional outpatient services only when physicians or practitioners reassign their billing rights to the CAH.
Learn how CAHs can prevent Fiscal Intermediary Shared System reason codes 31006 and 31007 (indicating that providers don’t have a reassignment on file in PECOS) claim denials:
- CAHs must submit the reassignment application through PECOS or the paper Form CMS-855I
- Starting in January 2026, we’ll deny CAH claims for professional services if a reassignment isn’t in PECOS
More Information:
- Information for Critical Access Hospitals (PDF) booklet
- Editing for Duplicate Processing for Practitioner Professional Services and CAH Professional Services (PDF) Medicare Administrative Contractor instruction
- Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services Office of the Inspector General report
Laboratories: Switch to Electronic Fee Coupons & CLIA Certificates
CMS is improving the Clinical Laboratory Improvement Amendments (CLIA) program by switching to electronic fee coupons and CLIA certificates. To continue getting these, eligible laboratories and providers that perform laboratory testing must switch to electronic email notifications by March 1, 2026; we’ll stop mailing paper versions after this date.
There are 3 ways to switch:
- Email your state agency (PDF)
- Contact your Accreditation Organization if you’re an accredited laboratory
- Fill out the CLIA Application for Certification (PDF) (form CMS-116), and check the box next to “Receive notifications including electronic certificates via email” in section I
Note: This doesn’t apply to CLIA-exempt states.
Lung Cancer: Help Your Patients Reduce Their Risk
Lung cancer remains one of the deadliest diseases in our country, claiming nearly one in five cancer deaths (Presidential Proclamation). During Lung Cancer Awareness Month, talk with your patients about how they can lower their lung cancer risk.
Medicare covers for patients who meet criteria:
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.
Information for Your Patients:
Compliance
Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters
In a report, the Office of the Inspector General found that Medicare improperly paid for catheters and kits. To avoid improper payments, review the Urological Supplies provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
Parenteral Nutrition: Prevent Claim Denials
In 2023, the improper payment rate for parenteral nutrition was 37.1%, with a projected improper payment amount of $86.4 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Parenteral Nutrition provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
MLN Matters® Articles
Ambulatory Surgical Center Payment System: October 2025 Update
Learn about updates (PDF) effective October 1, 2025:
- New Hospital Outpatient Prospective Payment System device pass-through category payable in ASCs
- New HCPCS code describing the insertion of a pleural-peritoneal shunt with intercostal pump chamber
- Drug, biological, and radiopharmaceutical coding
- Skin substitute products
Hospital Outpatient Prospective Payment System: October 2025 Update
Learn about updates (PDF) effective October 1, 2025, including coding and billing changes for:
- New COVID-19 monoclonal antibody and pleural-peritoneal shunt HCPCS codes
- CPT proprietary laboratory analyses and Hospital OPPS device categories
- Status indicators
- Drugs, biologicals, and radiopharmaceuticals
- Skin substitutes
New Waived Tests
Learn about updates (PDF) effective January 1, 2026:
- Clinical Laboratory Improvement Amendments requirements
- 2 new FDA-approved waived tests: codes, effective dates, and descriptions
DMEPOS Fee Schedule: October 2025 Quarterly Update — Revised
CMS removed a reference (PDF) to HCPCS Level II code E0716.
Publications & Multimedia
Health Care Code Sets — Revised
CMS added information about National Drug Codes.
Information for Patients
2026 Medicare & You Handbook
Share the 2026 Medicare & You Handbook with your patients and their caregivers. Encourage them to switch to electronic versions of the Handbook and Medicare Summary Notices.
New and important this year:
- Capping yearly out-of-pocket Part D prescription drug costs
- Meeting health care needs with Advanced Primary Care Management services
- Detecting colon cancer early through a wide range of screenings
- Helping fight fraud and cut waste
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