MLN Connects Newsletter for September 3, 2026

This federal investment will help fund technologies that advance telehealth, expand specialty care, and modernize health infrastructure across Arkansas.

The Trump Administration announced that a $149.3 million investment is being delivered to transform rural health care delivery for Arkansans through the federal Rural Health Transformation Program.

Read the full press release.

Georgia: $93.3M to Expand Telehealth Services, Advance Surgical Robotics & Transform Rural Health Care Access

This federal investment will help expand coordinated statewide care, strengthen the rural health workforce, and support technology-enabled health care access across Georgia.

The Trump Administration announced that a $93.3 million investment is being delivered to help rural hospitals advance new state-of-the-art models of care and improve health outcomes for Georgians through the federal Rural Health Transformation Program.

Read the full press release.

Hawaii: $58M to Deliver New Ambulances & Upgrade Emergency Communications Systems

This federal investment will help expand access, strengthen the health workforce, improve infrastructure, and advance technology for rural communities across Hawaii.

The Trump Administration announced that a $58 million investment is being delivered to improve health outcomes for Hawaiians through the federal Rural Health Transformation Program. This investment will strengthen Hawaii’s health care workforce, improve infrastructure, advance technology, and support innovative approaches tailored to the unique health care needs across the state.

Read the full press release.

Virginia: $122M to Expand Health Care Access, Workforce & Innovation

This federal investment will help provide resources to rural health providers and expand access to care across the Commonwealth.

The Trump Administration announced that a $122 million investment is being delivered to improve health outcomes for Virginians through the federal Rural Health Transformation Program. These investments will expand access to care by bringing more health care services closer to where people live. Funding will expand remote patient monitoring, virtual care, mobile clinics, maternal care, and increase community paramedics.

Read the full press release.

ColoSense™ Colorectal Cancer Screening Test: HETS Update Coming in January

Find out when your patient is eligible for colorectal cancer screening tests (PDF). Starting January 2027, the Medicare HIPAA Eligibility Transaction System (HETS) will return CPT code 0421U (non-invasive biomarker colorectal cancer screening test - ColoSense) history in eligibility responses.

See the National Coverage Determination 210.3: Colorectal Cancer Screening Tests – Non-Invasive Biomarker Testing (PDF) MLN Matters article for more information.

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).

Fraud, Waste & Abuse

CMS Prevents $1.6B in Fraudulent Medicare Laboratory Payments

CMS enforcement actions have stopped more than $1.6 billion in potentially improper Medicare laboratory payments since the start of the Trump Administration – further evidence that CMS’ efforts to crush fraud are working to protect taxpayer dollars and improve Medicare program integrity. This includes $732 million in savings from the revocation of 157 fraudulent lab providers from the Medicare program.

More Information:

Full press release
Crushing Fraud, Waste & Abuse webpage

Compliance

Oral Anticancer & Antiemetic Drugs Prevent Claim Denials

In 2024, the improper payment rate for oral anticancer drugs was 37.7%, with a projected improper payment amount of $3.2 million.  Learn how to bill correctly for these services. Review the Oral Anticancer & Antiemetic Drugs provider compliance tip for more information, including:

Denial reasons and how to prevent them
Refill and documentation requirements
Resources

Claims, Pricers & Codes

Medicare Physician Fee Schedule Database: October Update

See the instructions to your Medicare Administrative Contractor (MAC) (PDF) to learn about the October quarterly updates to the Medicare Physician Fee Schedule Database, including:

New codes
Procedure status changes
Short descriptor code revisions
Payment policy indicator changes

Your MAC will give you 30-days notice before they implement these changes. After that, they’ll adjust claims that you bring to their attention.

For more information, see the Medicare Claims Processing Manual, Chapter 23 (PDF), section 30.1.

National Correct Coding Initiative: October Update

Get the National Correct Coding Initiative (NCCI) first quarter edit files effective October 1, 2026, on these Medicare NCCI webpages:

Events

PEPPER Updates for Home Health Agencies & Partial Hospitalization Programs Webinar – September 24

Thursday, September 24 from 1–2 pm ET

Join CMS to review the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for:

Home health agencies released in August 2026
Partial hospitalization programs released in September 2026

The session will provide participants with guidance on navigating the recent changes, including a review of the reports.

Prior to the webinar, send your questions to CMS_CBRPEPPER@cms.hhs.gov. Visit the Training & Resources webpage for more information.

MLN Matters® Articles

HCPCS Codes Used for Skilled Nursing Facilities Consolidated Billing Enforcement: October 2026 Quarterly Update

Learn about coding updates (PDF):

Angiography, Lymphatic, Venous & Related Procedures Category
Excluded HCPCS codes
Vaccines (pneumococcal, flu, hepatitis B, or COVID-19)
Cardiovascular screening
Added and terminated codes
Codes removed from Part B File #1 and kept on Part B File #4

National Coverage Determination 210.3: Colorectal Cancer Screening Tests – Non-Invasive Biomarker Testing

CMS determined that non-invasive biomarker screening tests (PDF) are appropriate for colorectal cancer screening based on specific criteria, effective June 8, 2026.

Publications & Multimedia

Original Medicare vs. Medicare Advantage – Revised

CMS added information on prescription drug coverage (PDF).

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