News
- Outpatient Therapy Services: Clarifying Qualifications for Speech-Language Pathologists
- Cognitive Assessment: Recommend Medicare-Covered Services for Your Patients
Fraud, Waste & Abuse
Compliance
Claims, Pricers & Codes
- Clinical Laboratory Fee Schedule: COVID-19 & Influenza Virus Types A and B Test Code
- Drug Claims: Billing for Zero Charges
MLN Matters® Articles
- Hospice Payments: FY 2026 Update
- Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2026 Changes
- Medicare Claims Processing Manual, Chapter 18 Update: Hepatitis C Virus Preventive & Screening Services
- Medical Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2026 Update
From Our Federal Partners
News
Outpatient Therapy Services: Clarifying Qualifications for Speech-Language Pathologists
CMS clarified qualification requirements for speech-language pathologists when furnishing outpatient therapy services paid under Medicare Part B. Visit the Therapy Services webpage for more information.
Cognitive Assessment: Recommend Medicare-Covered Services for Your Patients
Your patients may tell you they’re having trouble remembering things, concentrating, or making everyday decisions. Their Medicare Summary Notice highlights that Medicare Part B covers a visit with their doctor or a specialist to talk about it and do an exam.
Recommend appropriate Medicare services, including:
Information for patients:
Fraud, Waste & Abuse
Duplicate Enrollment in Medicaid & Marketplace: New Fast Facts
CMS released new Fast Facts (PDF) about the ways we’re making sure people aren’t enrolled in more than one state Medicaid program or enrolled in both Medicaid and a Marketplace plan. Duplicate enrollment wastes taxpayer dollars and puts added strain on an already burdened health care system. Individuals identified with potential duplicate enrollment may need to take action to ensure they’re enrolled only in the program they’re eligible for.
We’re taking action to safeguard taxpayer funds and enhance the public’s confidence in these vital programs. Visit CMS.gov/fraud for more fast facts and resources.
Compliance
Manual Wheelchairs: Prevent Claim Denials
In 2023, the improper payment rate for manual wheelchairs was 42.6%, with a projected improper payment amount of $42.8 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Manual Wheelchairs provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
Claims, Pricers & Codes
Clinical Laboratory Fee Schedule: COVID-19 & Influenza Virus Types A and B Test Code
For combination tests that are read visually, CPT code 87812 QW will be effective January 1, 2026. Until then, laboratories may bill CPT code 87428 QW.
Drug Claims: Billing for Zero Charges
CMS updated information on the billing instructions for drug claims administered with zero charges.
More Information:
- Medicare Claims Processing Manual, Chapter 17 (PDF), section 70.2
- Instruction to your Medicare Administrative Contractor (PDF)
MLN Matters® Articles
Hospice Payments: FY 2026 Update
Learn about updates (PDF) effective October 1, 2025:
- Payment rates
- Inpatient and aggregate caps
- Wage index
Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2026 Changes
Learn about updates (PDF) effective October 1, 2025, for:
- Inpatient Prospective Payment System (IPPS)
- Long-Term Care Hospital Prospective Payment System
- Certain hospitals that CMS excludes from the IPPS
Medicare Claims Processing Manual, Chapter 18 Update: Hepatitis C Virus Preventive & Screening Services
Learn about hepatitis C virus updates (PDF) to the Medicare Claims Processing Manual effective June 27, 2024:
- Incorporating place of service code 19 as an approved setting for screening services
- Adding HCPCS code G0567 for screening procedures
Medical Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2026 Update
Learn about updates to the list of Medical Severity Diagnosis Related Groups (PDF) subject to the policy for replaced devices offered without cost or with a credit, including:
- Additions
- Conforming title changes
From Our Federal Partners
Ebola Outbreak in the Democratic Republic of the Congo
The CDC issued this Health Alert Network Health Advisory about a new outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC). EVD is a severe illness and is often fatal.
Currently, no suspected, probable, or confirmed EVD cases related to this outbreak have been reported in the U.S. or outside of the DRC. The risk of spread to the U.S. is considered low at this time. As a precaution, this Health Advisory summarizes CDC recommendations for U.S. public health departments, clinical laboratories, and health care workers about potential EVD case identification, testing, and biosafety considerations in clinical laboratories.
Read the full Health Advisory for more information.
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