MLN Connects Newsletter for September 10, 2026

This federal investment will help reduce barriers to primary and behavioral care, strengthen the rural health workforce, and improve access to health care services across Indiana.

The Trump Administration announced that a $120 million investment is being delivered to strengthen rural health and expand access to high-quality care for Hoosiers through the federal Rural Health Transformation Program. These investments will support locally driven solutions across 8 regions of the state, including removing barriers to technology, transportation, and health education. They will provide nutritional support and counseling with community-specific pilot programs that will address the impact food and nutrition have on health and health care. This funding will also help address prevention and management of chronic conditions, such as diabetes and obesity.

Read the full press release.

Michigan: $25M to Modernize Health Care Technology, Expand Telehealth & Improve High-Speed Internet Connectivity

This federal investment will help expand access and upgrade technology so doctors and patients can better connect and coordinate care across Michigan.

The Trump Administration announced that a $25 million investment is being delivered to improve health outcomes for Michiganders through the federal Rural Health Transformation Program. This investment will help rural communities in Michigan overcome barriers to care and build stronger, more connected health systems by modernizing technology; upgrading digital systems; improving data exchange and connectivity; and expanding telehealth, remote patient monitoring, and technology-driven care coordination.

Read the full press release.

New York: $76M to Strengthen Regional Coordination & Modernize Health Care Technology

This federal investment will strengthen regional partnerships, improve coordination of care, and expand access to health care services for rural New Yorkers.

The Trump Administration announced that a $76 million investment is being delivered to improve regional health care networks and deliver technology-enhanced primary care for New Yorkers through the federal Rural Health Transformation Program. This investment will support coordinated care to expand access to health care services, allowing rural hospitals and community providers to build and grow integrated care networks. The funds will also help address rural health care workforce needs through the expansion of enhanced clinical rotations, employer-based training programs, and remote-supported training technologies.

Read the full press release.

Rhode Island: $5.48M to Strengthen Health Care Workforce Pipeline

This federal investment will expand career and technical education in Rhode Island to help train the next generation of health care professionals.

The Trump Administration announced that a $5.48 million investment is being delivered to strengthen the health care workforce across rural communities in Rhode Island through the federal Rural Health Transformation Program. Rhode Island is committing this funding to 14 local education agencies and schools to expand health care-focused career and technical education opportunities for students across the state.

Read the full press release.

DMEPOS: Probationary Prior Authorization Starts October 15

Effective October 15, 2026, CMS will:

Implement a nationwide 1-year probationary prior authorization (PPA) process for newly enrolled suppliers and suppliers undergoing a change of ownership
Require prior authorization as a condition of payment for certain DMEPOS items (PDF) with dates of services on or after October 15

New and change of ownership suppliers are also subject to regular program oversight initiatives, including the following requirements:

Required prior authorization
Face-to-face encounter
Written order prior to delivery

More Information:

Partial Hospitalization Program: Download Your 2025 PEPPER

CMS released the 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for partial hospitalization programs. Your PEPPER helps you review your billing data to make sure claims are accurate. Use it 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 like longer patient stays

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 (I&A) Management 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 you can request it at the same time.
Your AO or AM must approve your request.

More Information:

Visit the Training & Resources webpage for more information about the release, the User Guide, and the upcoming webinar
See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
Contact the External User Services Help Desk

Electronic Health Records: Use Assistive Technology Correctly

Electronic health records (EHRs) may allow providers and suppliers to carry forward patient information from one visit to the next. This technology should only be used after you review and discuss information from the current visit and if it remains unchanged. Don’t solely rely on copied content without verifying continued accuracy because it can result in incomplete and inaccurate submissions that could affect coverage. Verify that all information you capture in the medical record accurately reflects your assessment, decision-making, and patient interactions. Conflicting information in a medical record can lead to claim denials, so ensure it’s up-to-date and accurate for the current visit.

For more information, see the Medicare Program Integrity Manual, Chapter 3 (PDF).

Fraud, Waste & Abuse

CMS Cracks Down on Massive $3.4B Medical Equipment Supplier Fraud Scheme

As part of the White House Anti-Fraud Task Force’s ongoing efforts to crush fraud in the health care system and protect taxpayer dollars, CMS has identified and is barring 11 medical supply companies with more than $3.4 billion in suspected fraudulent billing practices in 2025 and 2026 from receiving future Medicare Advantage (MA) Part C and Part D payments. These 11 DMEPOS suppliers:

Submitted no claims prior to 2025
Used improper billing practices for their claims
Billed for medical equipment to beneficiaries already deceased
Supplied equipment to beneficiaries who never requested or received it

Four of the suppliers had already been revoked from Original Medicare and began billing MA plans instead.

More Information:

Full press release
Crushing Fraud, Waste & Abuse webpage

Compliance

DMEPOS: Bill Correctly for Continuous Positive Airway Pressure Devices

In a report, the Office of Inspector General found that continuous positive airway pressure (CPAP) devices had the second highest improper payment amount in the DMEPOS category. Medicare paid claims that didn’t have the required documentation to support the services billed.

See the Continuous Positive Airway Pressure Devices & Accessories provider compliance tip to learn about Medicare coverage requirements for CPAP devices and the documentation you need.

Claims, Pricers & Codes

COVID-19 Vaccine: Updated Pricing for 2026–2027 Season

CMS updated COVID-19 vaccine payment allowances for the following CPT codes:

91304
91319
91320
91321
91322
91323

Visit the Vaccine Pricing webpage for more information, including billing codes, short descriptors, payment allowances, and effective dates. Use the vaccine crosswalk (ZIP) if you need to identify the corresponding National Drug Codes.

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

Starting October 1, 2026, rural health clinics (RHCs) and federally qualified health centers (FQHCs) must bill for distant site telehealth services using individual CPT or HCPCS codes that describe the service furnished and the appropriate telehealth modifier, instead of the single HCPCS code G2025. See the list of telehealth services.

Report the HCPCS code along with one of the following modifiers:

Modifier 93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system

The payment rate for telehealth services furnished by RHCs and FQHCs for CY 2026 is $97.53. The payment rate for these services will continue to be based on the average amount for all Physician Fee Schedule (PFS) services on the telehealth list, weighted by volume for those services reported under the PFS.

For more information, read the RHCs & FQHCs: Billing Distant Site Telehealth Services (PDF) MLN Matters® article.

MLN Matters® Articles

Medicare Secondary Payer Claim Processing for Certain Claim Adjustment Reason Codes

Learn about claim processing updates (PDF):

Your Medicare Administrative Contractor (MAC) processes several Claim Adjustment Reason Codes (CARCs) systematically
CMS is directing Medicare Part A MACs and shared systems on which CARCs will process automatically and which MACs will suspend for manual review or deny

Publications & Multimedia

Guidelines for Teaching Physicians, Interns & Residents – Revised

Learn what’s changed (PDF):

Added information about allowing teaching physicians to participate virtually in all teaching settings
Added CPT code 98016 (virtual check-in)
Deleted HCPCS code G2012

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