CMS Medicare Learning Network (MLN)


We encourage you to visit the Medicare Learning Network® (MLN), your source for official CMS Medicare fee-for-service (FFS) provider educational information. Get quick access to MLN Matters national provider education articles that help you understand new or revised Medicare policy and other educational products.

_________________________________________________
CPT, ADA, and AHA End User License Agreement for Providers
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.

Copyright© 2020, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816.

Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.





CMS Medicare Learning Network (MLN) Articles


Overview of the Repetitive Scheduled Non-emergent Ambulance Prior Authorization ModelGuidance on Coding and Billing Date of Service on Professional ClaimsProvider Enrollment - Unlicensed ResidentsProper Coding for Specimen Validity Testing Billed in Combination with Drug TestingAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 87811 and 87428Billing for Home Infusion Therapy Services On or After January 1, 2021Internet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention ProgramCurrent Medicare Coverage of Diabetes SuppliesUpdate to Chapter 10 of Publication (Pub.) 100-08 - Enrollment Policies for Home Infusion Therapy (HIT) SuppliersFoot Care Coverage GuidelinesIncorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any TypeUpdating Calendar Year (CY) 2021 Medicare Diabetes Prevention Program (MDPP) Payment RatesApril 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemProper Use of Modifier 59Medically Unlikely Edits (MUE) and Bilateral Surgical ProceduresAnnual Clotting Factor Furnishing Fee Update 2021Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) ProgramSection 1876 and 1833 Cost Plan Enrollee Access to Care through Original MedicareClaim Status Category and Claim Status Codes UpdatesUpdate to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021Next Generation Accountable Care Organization - ImplementationValue-Based Insurance Design (VBID) Model - Implementation of the Hospice Benefit ComponentMedicare Part B Home Infusion Therapy Services With The Use of Durable Medical EquipmentOverview of the Patient Driven Groupings ModelQuarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 UpdateReview of Opioid Use during the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV)2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsAmbulance Inflation Factor (AIF) for Calendar Year (CY) 2021 and Productivity AdjustmentAdd Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCSTherapy Codes UpdateOctober Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleNCD 20.4 Implantable Cardiac Defibrillators (ICDs)Billing for Services when Medicare is a Secondary Payer2021 Annual Update of Per-Beneficiary Threshold AmountsNational Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)July Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleNational Coverage Determination (NCD 90.2): Next Generation Sequencing (NGS) for Medicare Beneficiaries with Germline (Inherited) CancerNew Physician Specialty Code for Micrographic Dermatologic Surgery (MDS) and Adult Congenital Heart Disease (ACHD) and a New Supplier Specialty Code for Home Infusion Therapy ServicesClaim Status Category and Claim Status Codes UpdateCY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleMedicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment SystemMLN Connects for Thursday, March 4, 2021MLN Connects for Thursday, February 18, 2021MLN Connects for Thursday, December 17, 2020Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)MLN Connects Special Edition - Wednesday, December 9, 2020Medicare Coverable Services for Integrative and Nonpharmacological Chronic Pain ManagementMLN Connects Special Edition - Monday, December 14, 2020A Prescriber's Guide to the New Medicare Part D Opioid Overutilization Policies for 2019National Coverage Determination (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM)Claim Status Category and Claim Status Codes UpdateMLN Connects Special Edition - Friday, December 18, 2020: COVID-19: Add-on Payment for New Treatments.FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsAccepting Payment from Patients with a Medicare Set-Aside ArrangementQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 UpdateReduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing BenzodiazepinesFAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as InpatientsUpdate to the Medicare Claims Processing ManualAppropriate Use Criteria (AUC) for Advanced Diagnostic Imaging - Approval of Using the K3 Segment for Institutional ClaimsProvider Compliance Tips for Polysomnography (Sleep Studies) - RevisedAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 87426Payments and Payment Adjustments under the Patient-Driven Groupings ModelQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 UpdateMLN Connects for Thursday, January 21, 2021NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR)Telehealth Expansion Benefit Enhancement Under the Pennsylvania Rural Health Model (PARHM) - Implementation2021 Annual Update to the Therapy Code ListMLN Connects for Thursday, January 7, 2021Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization RequirementsCalendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Services Subject to Reasonable ChargeOctober 2020 Update of the Ambulatory Surgical Center (ASC) Payment System2021 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) UpdateSummary of Policies in the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services ListLocal Coverage Determinations (LCDs)April Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2020 UpdateReminder on Billing Requirements Implemented for non-OPPS ProvidersMedicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 TestingMLN Connects for Thursday, February 11, 2021July 2020 Update of the Ambulatory Surgical Center (ASC) Payment SystemManual Update to Pub. 100-04, Chapter 38, to Remove Identification of Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico SectionNational Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)Educational Resources to Assist Chiropractors with Medicare BillingInfluenza Vaccine Payment Allowances - Annual Update for 2020-2021 SeasonMLN Connects for Thursday, December 10, 2020Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) & PC Print UpdateQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2021 UpdateApril Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleQuarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge PaymentMLN Connects for Wednesday, December 23, 2020Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final RulesHealthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsAddition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635MLN Connects Special Edition - Tuesday, December 22, 2020Certifying Patients for the Medicare Home Health BenefitNew Medicare Beneficiary Identifier (MBI) Get It, Use ItUpdated Billing Requirements for Home Infusion Therapy (HIT) Services on or After January 1, 2021New Provider Enrollment Administrative Action AuthoritiesClaims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B ServicesRepayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementApril 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemAssisted Suicide Funding Restriction Act of 1997 (P.L. 105-12)January 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemCommon Working File (CWF) Edits for Medicare Telehealth Services and Manual UpdateInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs): July 2021Special Provisions for Radiology Additional Documentation RequestsNew Waived TestsAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code 876362021 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction ListMLN Connects for Thursday, May 13, 2021Addition of the Shared System CWF to the Business Requirements for the Healthcare Common Procedure Coding System (HCPCS) Codes U0002QW and 87635QW Mentioned in Change Request 11765Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) - October 2021National Coverage Determination (NCD) 210.3 - Screening for Colorectal Cancer (CRC) - Blood-Based Biomarker TestsInternational Classification of Diseases, 10th Revision (ICD10) and Other Coding Revisions to National Coverage Determination (NCDs) - July 2021 Health Care Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) EditsJuly 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesAddition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 0240U, 0241U, and 87637Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2021National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2021 UpdateMLN Connects Special Edition - Monday, June 28, 2021MLN Connects Special Edition - Thursday, July 1, 2021October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) EnforcementJuly 2021 Update of the Ambulatory Surgical Center [ASC] Payment SystemJuly Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee ScheduleSection 50 in Chapter 30 of Publication (Pub.) 100-04 Manual UpdatesImplement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Health Care (CAQH) COREQuarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 27.3, Effective October 1, 2021October 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesMLN Connects Special Edition: Monday, August 2, 2021MLN Connects for Thursday, August 5, 2021National Coverage Determination (NCD) RemovalClinical Laboratory Fee Schedule: Medicare Travel Allowance Fees for Collection of SpecimensMedicare Coverage for Chiropractic Services: Medical Record Documentation Requirements for Initial and Subsequent VisitsInternet Only Manual Updates to Publication (Pub.) 100-02 to Implement Updates to Policy and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF))New Waived TestsModifications/Improvements to Value-Based Insurance Design (VBID) Model - ImplementationInternet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)MLN Connects for Thursday, August 12, 2021MLN Connects Special Edition: Friday, August 13, 2021Changes to the Laboratory National Coverage Determination [NCD] Edit Software for October 2021MLN Connects Special Edition: Monday, August 16, 2021MLN Connects for Thursday, August 19, 2021MLN Connects Special Edition for Tuesday, August 24, 2021MLN Connects for Thursday, August 26, 2021MLN Connects for Thursday, September 2, 2021Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Health Care (CAQH) COREMedicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)MLN Connects for Thursday, September 9, 2021MLN Connects Special Edition for Thursday, September 9, 2021Annual Clotting Factor Furnishing Fee Update 20222022 Annual Update for the Health Professional Shortage Area (HPSA) Bonus PaymentsQuarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2021 UpdateQuarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge PaymentClaims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve RegurgitationMLN Connects for Thursday, September 16, 2021National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing WoundsOctober 2021 Update of the Ambulatory Surgical Center (ASC) Payment SystemMLN Connects Special Edition for Monday, September 20, 2021MLN Connects for Thursday, September 23, 2021MLN Connects Special Edition for Friday, September 24, 2021Influenza Vaccine Payment Allowances - Annual Update for 2021-2022 SeasonMLN Connects Special Edition for Monday, September 27, 2021October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee ScheduleInternational Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) - January 2022Medicare Clarifies Recognition of Interstate License Compacts PathwaysMLN Connects for Thursday, September 30, 2021Training Medicare Patients on Use of Home Glucose Monitors and Related Billing InformationMLN Connects for Thursday, October 7, 2021Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 28.0, Effective January 1, 2022January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing FilesChanges to the Laboratory National Coverage Determination (NCD) Edit Software for January 2022MLN Connects for Thursday, October 14, 2021Claim Status Category and Claim Status Codes UpdateNational Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell TherapyNew/Modifications to the Place of Service (POS) Codes for TelehealthMLN Connects for Thursday, October 21, 2021MLN Connects Special Edition: Friday, October 22, 2021