News
CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements
CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice & Home Health Agency Enrollment Moratoria
Clinical Diagnostic Laboratories: Report Your Data Through July 31
Care Compare: CY 2024 Doctors & Clinicians Preview Period Open until June 11
CMS Identifies Participants in Mandatory Ambulatory Specialty Model
National Mental Health Awareness Month
Compliance
Remote Patient Monitoring: Use & Bill Correctly
Suction Pumps: Prevent Claim Denials
Claims, Pricers & Codes
Bone Growth Stimulators Reclassified as Class II Devices: Get Updated Billing Information
MLN Matters® Articles
Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement – Revised
From Our Federal Partners
2026 Multi-country Hantavirus Cluster Linked to Cruise Ship
Support is available for tracking the status of enrollment applications, resolving common questions and completing the enrollment process. Our provider enrollment webpages offer a wealth of resources and tools, and our May Medicare Navigator Workshop Series, Provider Enrollment Preparation webinars provide engaging overviews regarding how to use them.
View the most recent updates for our LCDs and articles. Urine-based Biomarkers in Patients with Microhematuria has been posted for comment.
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider for reason code 34554 if modifier ER, PO, or PN is billed on all service lines and the practice location address is missing from the claim.
Make sure your facility enrollment is current and the practice location address on the claim exactly matches PECOS, as displayed in FISS (Shortcut 1D – Provider Practice Address).
The Supply codes list has been updated.
Effective May 11, CMS requires that providers using a third-party vendor to conduct their beneficiary eligibility transactions must attest to their relationship via the HIPAA Eligibility Transaction System (HETS) EDI Enrollment Tool. Follow these instructions to complete the required attestation.
This article outlines billing, payment methodology, and documentation requirements for non-sheet skin substitute products. It clarifies that the appropriate application codes must be submitted on the same claim to avoid rejection.
CMS is testing a new Original Medicare payment model that focuses on patient outcomes rather than the volume of services. Continue reading to learn about the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model and how to apply.
Act now to participate in the first cohort, which begins July 5, 2026, applications must be submitted by May 15, 2026.
Our Medicare Navigator Workshop Series, Provider Enrollment Preparation, kicks off tomorrow and you don’t want to miss this opportunity. The first webinar in our series provides an overview of the Part A provider enrollment process, application submission options, and reviews the information and documentation needed to prepare for enrollment. Take the first step and register today.
Read this article to learn more about the CERT awareness month campaign focusing on responding to CERT documentation requests.
Need the status of your WISeR prior authorization? The WISeR Status Tool has been added under the PRIOR AUTH dropdown in Novitasphere. This feature allows providers to view the WISeR model status of authorization requests submitted in Novitasphere. If you have questions concerning the WISeR program, the answer may be a click away. Review the common WISeR questions and answers.
We welcome beginners to advanced professionals to attend our free, Medicare Navigator Workshop Series in May, focused on Provider Enrollment Preparation. Become better equipped to navigate the Medicare Part A and B enrollment process by attending this three-part series. Reserve your seat and register today.
News
Electronic Prior Authorization Improvements: Get Involved & Start Testing
Medicare GLP-1 Bridge Starts July 1
CMS Extends Deadlines for GENEROUS Model Applications for Drug Manufacturers & States
HETS Action Required: Enroll Third-Party Vendors for Access by May 11
Open Payments: Review Your Data by May 15
Hospitals: Report Clinical Diagnostic Laboratory Data by July 31
DMEPOS: Send Enrollment Appeals & Rebuttals to Your National Provider Enrollment Contractor
Medicare Shared Savings Program: Application Toolkit Materials
Compliance
Global Surgery: Accurately Report Postoperative Visits
Events
CCSQ Quarterly Stakeholder Webinar – May 12
by CMS Administrator Dr. Mehmet Oz
A common practice imposed by health insurers on patients and providers is their intrepid need to second-guess clinician treatment decisions by requiring prior authorizations before paying a claim. The current prior authorization process creates unnecessary delays for patients, burdens health care providers with excessive paperwork, and erodes trust between payers and health care providers, even though all share the same goal: delivering high-quality patient care.
It is way past time to axe the fax, kill the clipboard, and put patients over paperwork.
More Information:
Learn what appeal functions can be completed in the Novitasphere online portal.
The May 2026 electronic billing newsletter is now available.
Congratulations to new providers graduating in 2026! Are you prepared to enroll in the Medicare program? Don’t miss out on our Medicare Navigator Workshop Series, Provider Enrollment Preparation. This 3-part series provides an overview of the provider enrollment process, application submission options, and reviews the information and documentation needed to prepare for enrollment for Part A and Part B. Take the first step and register today.
View the most recent updates for our LCDs and articles. Three articles have been revised.
News
CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices
Clinical Diagnostic Laboratories: Required Reporting Starts May 1
HETS Action Required: Enroll Third-Party Vendors for Access by May 11
Nurses May Qualify for Up to $40,000 in Student Loan Repayment
Reduce Chronic Disease & Improve Health with Physical Activity and Nutrition
Compliance
Manual Wheelchairs: Prevent Claim Denials
Claims, Pricers & Codes
Ultrasound Abdominal Aortic Aneurysm Screening: Updated Coding Information
Events
CCSQ Quarterly Stakeholder Webinar – May 12
MLN Matters® Articles
Vaccine Administration National Fee Schedule: July 2026 Quarterly Update
Stay of Enrollment – Revised
Publications & Multimedia
Clinical Laboratory Fee Schedule: Reporting Private Payor Data
Fix Death Date Errors in Medicare Records
Who is the WISeR model participant responsible for reviewing prior authorization requests for Oklahoma providers?
Review our informative article to learn more about Humata Health.
Who is the WISeR model participant responsible for reviewing prior authorization requests for Texas providers?
Review our informative article to learn more about Cohere Health.
As announced by CMS on April 23, providers using a third-party vendor to conduct their beneficiary eligibility transactions must attest to their relationship via the HIPAA Eligibility Transaction System (HETS) EDI Enrollment Tool by May 11. This article includes the instructions to follow and a link to the CMS announcement.
News
2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources
Updated Behavioral Health Strategy
Clinical Diagnostic Laboratories: Get Ready to Report Starting Next Week
HETS Action Required: Enroll Third-Party Vendors for Access by May 11
Open Payments: Review Your Data by May 15
Hospice Levels of Care & How to Bill for Service Intensity Add-On Payments
Hospitals: Accurately Report Allogeneic Hematopoietic Stem Cell Acquisition Costs
Compliance
Lower Limb Orthoses: Prevent Claim Denials
Claims, Pricers & Codes
Vaccine Coding for Institutional Claims: Reporting Condition Code A6
HCPCS Application Summaries & Coding Determinations: Drugs & Biologicals
Events
HCPCS Public Meeting – June 1–2
MLN Matters® Articles
Low-Volume Hospital Payment Adjustment & the Medicare-Dependent Hospital Program: FY 2026 Extensions
Publications & Multimedia
Clinical Laboratory Fee Schedule Data Collection & Reporting Webinar Recording
Medicare Preventive Services – Revised
Do you know which procedures need prior authorizations in Texas and Oklahoma? View the webinar recordings for our last training conducted on April 8th for the WISeR model and don’t forget to utilize the Prior Authorization Code Lookup Tool to identify which services require a prior authorization.
This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s General Documentation Requirements.
Representatives from all four DME MAC jurisdictions will join the Part A/B education staff to discuss the coverage criteria, documentation requirements, and common errors.
Register today!
Effective January 3, 2026, new site verification service contractors began conducting site visits for applications processed by Novitas Solutions. This transition is a one-time change that temporarily extends our processing timeline for any application that requires a site visit.
Due to the transition, we are experiencing delays in receiving results from the site verification service contractor. CMS and Novitas are aware of the current delays and will continue working together on a resolution.
We appreciate your patience as we navigate this temporary challenge.
View our latest article: SPRAVATO®= (esketamine) nasal spray, CIII- Place of service (POS) requirements
We're re-sending this special edition to update the webinar link for today’s event. See the updated announcement.
News
CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System
HETS Action Required: Enroll Third-Party Vendors for Access by May 11
ACCESS Model Application Period Extended to May 15; First Applicants Accepted to Join
DMEPOS Therapeutic Shoes: Document Qualifying Conditions
MLN Matters® Articles
Ambulatory Surgical Center Payment System: April 2026 Update
Critical Access Hospitals: Certified Registered Nurse Anesthetist Bypass for Reason Codes 31006 & 31007
Prospective Payment System Hospital Interim Billing: New Monthly Adjustment Process
Cardiac Contractility Modulation for Heart Failure – Revised
Publications & Multimedia
Annual Wellness Visit – Revised
Clinical Laboratory Fee Schedule – Revised
Novitas Solutions will be closed for training in the afternoon on 05/07/2026, 05/14/2026, 05/21/2026, and 05/28/2026.
Overview of the CMS Interoperability Standards & Prior Authorization for Drugs Proposed Rule Webinar – April 16
CMS is hosting an informational webinar to provide an overview of the proposed rule and highlight key provisions, including proposed updates to interoperability standards and prior authorization requirements. We encourage all interested parties to attend and learn more about how these proposals may affect patients, payers, providers, and the broader health care system.
Proposed Payment Rule
Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System Proposed Rule: FY 2027
News
CMS Proposes Major Reforms to Speed Up Patient Access to Drugs, Increase Transparency, & Reduce Administrative Burden
CMS sponsors a variety of programs that support efforts to safeguard beneficiaries’ access to reasonable and necessary items and services while reducing improper Medicare billing and payments. Through prior authorization and pre-claim review initiatives, CMS helps ensure compliance with Medicare rules. Review our WISeR (Wasteful and Inappropriate Service Reduction) model resources for more information regarding program requirements, including the services and provider types involved in the program, submission guidelines and more.
Our event calendar has been updated and new events are open for registration.
Proposed Payment Rules
Skilled Nursing Facility Prospective Payment System Proposed Rule: FY 2027
Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule: FY 2027
Inpatient Psychiatric Facility Prospective Payment System Proposed Rule: FY 2027
Hospice Wage Index and Payment Rate Update & Hospice Quality Reporting Program Requirements: FY 2027
News
Hospital Price Transparency: Get Guidance on New Requirements
Short-Term Acute Care Hospitals: Download Your Quarter 4 FY 2025 PEPPER
Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1
Compliance
Skilled Nursing Facilities: Accurately Report Your Related Party Costs
Claims, Pricers & Codes
Integrated Outpatient Code Editor Version 27.1
Events
Clinical Lab Fee Schedule Data Collection Webinar – April 16
Medicare Cost Report E-Filing System Webinar – April 22
MLN Matters® Articles
DMEPOS Fee Schedule: April 2026 Quarterly Update
National Coverage Determination 20.19: Ambulatory Blood Pressure Monitoring – Revised
From Our Federal Partners
Medetomidine in the U.S. Illegal Fentanyl Supply Increasing Risk for Overdose & Severe Withdrawal Syndrome
Effective April 27, 2026, Novitas Solutions INC will be changing banks from US Bank to JP Morgan Chase. To minimize issues in the provider/beneficiary community, please make sure that all received checks issued from the US Bank account (checks issued April 27, 2026 and prior) are deposited timely prior to the closure of our US Bank account on July 31, 2026. After that date, any outstanding US Bank issued checks will become invalid and a replacement check from the JP Morgan Chase account will be reissued during the week of August 10, 2026. Impacted providers/suppliers/beneficiaries will receive written notification that provides a cross reference from the voided US Bank check number to the replacement check from JPMorgan Chase.
View the most recent updates for our LCDs and articles. An LCD and two articles have been revised.
This article has been revised to include instructions for completing the PAR, the PAR review and decision process, guidance on multiple or staged procedures, as well as best practices, tips and reminders related to the PAR.
Need the status of your WISeR prior authorization? The WISeR Status Tool has been added under the PRIOR AUTH dropdown in Novitasphere. If you have questions concerning the WISeR program, review the common WISeR questions and answers.
Our Medicare Navigator Program is back with webinars focused on supporting providers successfully navigating Medicare program requirements and submitting complete, and accurate transactions. April’s Medicare Navigator Program spotlights Part A billing. Review our event calendar for the full listing of events and opportunities to register.
View the most recent updates for our LCDs and articles. The comment period for Trigger Point Injections is now closed.
A new article has been added on the Revision to social determinants of health risk assessment (HCPCS code G0136). Take time to review this article.
Eligibility and duplicate claims remain the top trending denials. Reduce preventable errors by reviewing the updated quarterly top claim denials.
News
HHS & CMS Announce Healthcare Advisory Committee Members to Improve Patient Care and Modernize the U.S. Healthcare System
CMS Marks Milestone in Expanding Patient-Centered Innovation with Substance Access Beneficiary Engagement Incentive
Accountable Care Organizations: Apply to the New LEAD Model
New ASPIRE Model to Deliver Support to Children and Youth with Complex Medical Needs
Hospitals: OPPS Drug Acquisition Cost Survey Deadline Extended to April 7
ESRD Prospective Payment System: XPHOZAHTM Included in Bundled Payment
Clinical Diagnostic Laboratory Reporting: Are You an Applicable Lab?
Compliance
Evaluation and Management Services & Intravitreal Injections: Bill Correctly
Therapeutic Footwear: Prevent Claim Denials
Claims, Pricers & Codes
Method II Critical Access Hospitals: Reprocessing Certain Claims with Reassigned Billing Rights
Events
Quarter 4 FY 2025 PEPPER for Short-Term Acute Care Hospitals Webinar – April 7
MLN Matters® Articles
HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement: July 2026 Quarterly Update
Hospital Outpatient Prospective Payment System: April 2026 Update – Revised
National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension – Revised
Learn how using these two products together can make electronic claim submission free and easy.
There will be Common Working File (CWF) "dark days" Friday, April 3, 2026, through Sunday, April 5, 2026, due to the April 2026 release installation. The interactive voice response (IVR) unit will have limited availability. The portals will be available for eligibility inquiries. In addition, the Customer Contact Center will be closed April 3, 2026.
To enhance efficiency and ensure the secure handling of appeal information, effective May 1, 2026, all providers will be required to use Novitasphere to check appeal status and access duplicate appeal decision letters.
Note: Customer Service Representatives will no longer provide appeal status updates or send duplicate decision letters by phone starting May 1, 2026.
If you haven’t registered for the portal yet, we strongly encourage you to do so now to avoid delays in accessing appeal decisions.
View the most recent updates for our LCDs and articles. An LCD has been posted for notice to become effective May 17.
The Redetermination Notices feature has been renamed to General Inquiry and Redetermination Correspondence. This feature will now include General Inquiry response letters.
View the most recent updates for our LCDs and articles. The comment period for a proposed LCD is currently open and will close April 4.
Discover a streamlined space designed to deliver clear insight about our local pricing process.
Mark your calendar for the upcoming WISeR model webinar coming April 8. Registration is open. If you missed any of our previous webinars, view the webinar recordings and don’t forget to utilize the Prior Authorization Code Lookup Tool to identify which services require a prior authorization.
Our Medicare Navigator Program is back with webinars focused on supporting providers successfully navigate Medicare program requirements and submit complete, accurate transactions. April’s Medicare Navigator Program spotlights Part A Claims Billing.
The code list for drugs has been updated.
News
CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98M a Year
Hospitals: OPPS Drug Acquisition Cost Survey Deadline Extended to April 7
Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1
Nutrition-Related Health Conditions: Recommend Medicare Preventive Services
Compliance
Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
Claims, Pricers & Codes
Stem Cell Transplant National Coverage Determination: Reprocessing Certain Part A Claims
Medicare Part B Drug Pricing Files & Revisions: April Update
Events
Quarter 4 FY 2025 PEPPER for Short-Term Acute Care Hospitals Webinar – April 7
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: April 2026 Update
Publications & Multimedia
CMS Burden Reduction Conference Videos
Medicare Coverage of Diabetes Supplies – Revised
From Our Federal Partners
VA Family Member Programs: Updated Guidance for Decision Reviews & Appeals
Review our informative article to learn more about Humata Health, the WISeR model participant responsible for reviewing prior authorization requests for Oklahoma providers. The services under the WISeR model are outlined in Appendix A of the Wasteful and Inappropriate Service Reduction (WISeR) Model Provider and Supplier Operational Guide.
Review our informative article to learn more about Cohere Health, the WISeR model participant responsible for reviewing prior authorization requests for Texas providers. The services under the WISeR model are outlined in Appendix A of the Wasteful and Inappropriate Service Reduction (WISeR) Model Provider and Supplier Operational Guide.
Review this article to learn more about CERT reviews for vaccine and roster billed claims.
Our event calendar has been updated and new events are open for registration.
Please read our new article for significant changes and revisions to the MDPP program for calendar year 2026.
The code lists for Ambulatory Surgery Center (ASC) device codes and Drugs have been updated.
News
CMS Announces Manufacturer Participation in Third Cycle of Medicare Drug Price Negotiation
Quality Payment Program: Medicare Shared Savings Program ACOs Must Submit Quality Data by March 31
Hospitals: Apply for Additional Residency Positions by March 31
Hospitals: It’s Not Too Late to Submit Data for OPPS Drug Acquisition Cost Survey
Short-Term Acute Care Hospitals: Download Your Quarter 4 FY 2025 PEPPER
Medicare Shared Savings Program: Application Deadlines for January 1, 2027, Start Date
ESRD Prospective Payment System: Furnishing Drugs & Biological Products Included in Bundled Payment
Advance Beneficiary Notice of Noncoverage: Updated Form
Important Message from Medicare & Detailed Notice of Discharge: Updated Forms
Claims, Pricers & Codes
Inpatient Psychiatric Facilities Prospective Payment System: April 2026 Coding Updates
Events
Average Sales Price Data Collection System Training Webinar – April 14
MLN Matters® Articles
Cardiac Contractility Modulation for Heart Failure – Revised
ICD-10 & Other Coding Revisions to National Coverage Determinations: April 2026 Update – Revised
Publications & Multimedia
Billing Medicare Part B for Insulin with New Limits on Patient Monthly Coinsurance – Revised
Our Medicare Navigator Program is back with webinars focused on supporting providers successfully navigate Medicare program requirements and submit complete, accurate transactions. March’s Medicare Navigator Program spotlights the Foundations of Compliance.
March 24, Foundations of Compliance: Locating and Utilizing Local Coverage Determinations (LCDs)
March 26, Foundations of Compliance: Purposeful Documentation
Review our Event Calendar for the full listing of events and opportunities to register.
Mark your calendar for the upcoming WISeR model webinar coming April 8. Monitor our educational event calendar to know when registration is open. If you missed any of our previous webinars, view the webinar recordings and don’t forget to utilize the Prior Authorization Code Lookup Tool to identify which services require a prior authorization.
Revised:
This article is for physicians, suppliers, and other providers billing MACs for services.
Staying informed and connected benefits your personal growth and supports your organization’s success – making it an investment. Bring back practical insights and resources to your organization by attending our Foundations of Compliance workshop series in March. Our newly released compliance awareness article also provides tools and resources to guide informed decision making, reduce risk, and identify methods to prepare and adapt to change.
News
CMS Strengthens Patient Protections & Accountability in Organ Donation System
Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Hospital Price Transparency: Enforcement of 2026 Requirements Starts April 1
Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1
Optimal Health for All Within Nation’s Health & Long-Term Care Systems
Emergency Preparedness: Find Out How to Prevent Deficiencies
Compliance
Skilled Nursing Facilities: Identify & Prevent Improper Part D Payments for Drugs
Claims, Pricers & Codes
Quality Payment Program: Claim Adjustments to Correct Conversion Factor
HCPCS Application Summaries & Coding Determinations: Non-Drug and Non-Biological Items & Services
Publications & Multimedia
Medicare Payment Systems — Revised
Information for Patients
Medicare.gov Enhanced Log In
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology and other codes claims submissions indicated in this article. Novitas requests specific documentation with submission of these codes. Please note that the pathology and laboratory codes list has been updated.
Whether you are looking to create a customized compliance program or seeking support with understanding Medicare regulatory guidance, Novitas offers resources for all types of Medicare personnel ranging from the seasoned auditor to the newly enrolled provider.
Read the attached article for the latest chiropractic services information.
CMS sponsors a variety of programs that support efforts to safeguard beneficiaries’ access to reasonable and necessary items and services while reducing improper Medicare billing and payments. Through prior authorization and pre-claim review initiatives, CMS helps ensure compliance with Medicare rules. Review our WISeR model resources for more information regarding program requirements, including the services and provider types involved in the program, submission guidelines and more.
Effective for dates of service (DOS) on and after January 1, 2026, addition of administration of a standardized, evidence-based assessment of physical activity and nutrition, 5 - 15 minutes, not more than every 6 months has been added as an optional element to the annual wellness visit.
CMS released a new version of form CMS-460 (version 12/28). The former version (11/22) will no longer be accepted by the MACs after March 6, 2026.
When submitting appeals using the Medicare Part A Redetermination and Clerical Error Reopening Request Form, if unsure whether the denial is connected to Prior Authorization Program Initiatives, we encourage you to use the Prior Authorization Code Lookup tool to confirm before submitting. Selecting the correct appeal type helps prevent processing delays and ensures your request is routed appropriately. The tutorial, How to Complete the Medicare Part A Redetermination and Clerical Error Reopening Request Form provides step-by-step instructions for completion.
View CAC meeting minutes from our meeting on February 19, 2026, on the use of urine-based biomarkers in patients with microhematuria.
Our Medicare Navigator Program is back with webinars focused on supporting providers successfully navigate Medicare program requirements and submit complete, accurate transactions. March’s Medicare Navigator Program spotlights the Foundations of Compliance.
March 10, Foundations of Compliance: Establishing a Compliance Program
March 12, Foundations of Compliance: Locating and Utilizing National Coverage Determinations (NCDs)
March 24, Foundations of Compliance: Locating and Utilizing Local Coverage Determinations (LCDs)
March 26, Foundations of Compliance: Purposeful Documentation
Successfully participate in all webinars offered within this program and earn the Medicare Navigator Compliance badge and publish your name on our honorary Medicare Navigator Notable Wall. Review our Event calendar for the full listing of events and opportunities to register.
In March we are offering the following compliance-focused events:
The Medicare Navigator Foundations of Compliance Workshop series is intended to support Medicare compliance, accurate billing and documentation standards.
New to Medicare? Whether you are a provider, biller, coder, compliance officer or serve in some other role, let us connect you to Medicare program requirements and resources by attending our New Provider workshop series.
News
DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies
CMS to Lower Drug Costs & Improve Care by Extending Deadline for GENEROUS Model Application
Laboratories: We’ve Transitioned to Paperless Operations
No-Pay Medicare Summary Notice Mailing Frequency Changed to Every 180 Days
Compliance
Opioid Use Disorder: Learn about Services to Help Your Patients Continue Treatment
Major Hip & Knee Replacement or Reattachment of Lower Extremity: Prevent Claim Denials
Claims, Pricers & Codes
National Correct Coding Initiative: April Update
Publications & Multimedia
2026 Medicare Part C and Part D Reporting Requirements & Data Validation – Revised
View the most recent updates for our LCDs and articles.
Questions concerning the WISeR program? Review our WISeR FAQs.
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology and other codes claims submissions indicated in this article. Novitas requests specific documentation with submission of these codes. Please note that the other codes list has been updated.
Read these tips for completing the Novitasphere enrollment form correctly.
News
Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
MAC MBI Lookup Tool: Keep Your Access During Enhanced Monitoring
Medicare Outpatient Observation Notice: Get Updated Version in English & Spanish
Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Hospitals: One Month Left to Submit Data for OPPS Drug Acquisition Cost Survey
Compliance
DME: Complying with Proof of Delivery Requirements
Spinal Orthoses: Prevent Claim Denials
Claims, Pricers & Codes
Hypoglossal Nerve Neurostimulator: New Codes, Effective January 1, 2026
Therapy Services: CY 2026 KX Modifier Threshold Amounts
Screening for Hepatitis C Virus National Coverage Determination: Clarified Billing Requirements
Medicare Physician Fee Schedule Database: April Update
MLN Matters® Articles
Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment: April 2026 Update
HCPCS Codes & Clinical Laboratory Improvement Amendments Edits: April 2026
Vaccine Administration National Fee Schedule: April 2026 Update
Publications & Multimedia
Intravenous Immune Globulin Items & Services – Revised
Medicare Diabetes Prevention Program Expanded Model – Revised
CMS updated the wasteful and inappropriate service seduction (WISeR) model provider and supplier operational guide. Please review the updates made to the appendices.
New:
This article is for physicians, suppliers, and other providers billing MACs for services.
This article is for laboratories, and other providers billing MACs for laboratory services.
This article is for laboratories, physicians, and other providers billing MACs for laboratory services.
View the most recent updates for our LCDs and articles.
View our updated instructions.
Review our informative article to learn more about Humata Health, the WISeR model participant responsible for reviewing prior authorization requests for Oklahoma providers. The services under the WISeR model are outlined in Appendix A of the Wasteful and Inappropriate Service Reduction (WISeR) Model Provider and Supplier Operational Guide.
Review our informative article to learn more about Cohere Health, the WISeR model participant responsible for reviewing prior authorization requests for Texas providers. The services under the WISeR model are outlined in Appendix A of the Wasteful and Inappropriate Service Reduction (WISeR) Model Provider and Supplier Operational Guide.
Our event calendar has been updated and new events are open for registration.
Novitas seeks your input on establishing pricing under the Medicare program for the 2026 Gapfill laboratory test codes.
This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s General Documentation Requirements.
Representatives from all four DME MAC jurisdictions will join the Part A/B education staff to explain what is required in the medical records, orders, and related documentation to support the coverage. Register today.
Online registration for the Friday, March 6 open meeting is now available, and presenter registration will close at noon ET on Wednesday, March 4.
Important: Our open meeting will be held via webinar only. Please view our proposed local coverage determination open meetings web page for specific guidelines and other helpful information.
News
Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate
Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Compliance
Intermittent Urinary Catheters: Medicare Improperly Paid Suppliers
Surgical Dressings: Prevent Claim Denials
Claims, Pricers & Codes
Home Health Prospective Payment System Grouper: April Update
CMS sponsors a variety of programs that support efforts to safeguard beneficiaries’ access to reasonable and necessary items and services while reducing improper Medicare billing and payments. Through prior authorization and pre-claim review initiatives, CMS helps ensure compliance with Medicare rules. Review our WISeR (Wasteful and inappropriate service reduction) model for coverage policies, documentation requirements and prior authorization request submission requirements.
View the most recent updates for our LCDs and articles.
Due to system maintenance, Novitasphere will be unavailable Saturday, February 21 at 7 p.m. through 3 a.m. Sunday, February 22 ET. We apologize for any inconvenience.
News
Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs
Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Compliance
Global Surgery: Accurately Report Postoperative Visits
Optometry Services at Nursing Facilities: Bill Correctly
Events
2026 CMS Burden Reduction Conference – February 25
MLN Matters® Articles
Hospital Outpatient Prospective Payment System: January 2026 Update
ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update
Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease – Revised
National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension – Revised
Missed the latest webinar view the webinar recording. Don’t forget to utilize the Prior Authorization Code Lookup Tool.
View the most recent updates for our LCDs and articles.
Revised common questions and answers posed during our webinars on the WISeR model prior authorization program.
Recent legislation authorized an extension of many Medicare telehealth flexibilities through December 31, 2027. Review the Telehealth services and Telehealth services modifiers articles for the most recent updates.
Review the new article for cardiac lithotripsy: a modern approach to coronary artery calcification.
News
Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Compliance
Skilled Nursing Facilities: Accurately Report Your Related Party Costs
MLN Matters® Articles
Acute Kidney Injury & ESRD Billing: Ending the AX Modifier Requirement
Ambulatory Surgical Center Payment: January 2026 Update
Publications & Multimedia
Behavioral Health Integration Services — Revised
Information for Rural Health Clinics — Revised
Medicare Preventive Services — Revised
Online registration for the Thursday, February 19 Contractor Advisory Committee (CAC) meeting is now available. Important: Our CAC meeting will be held via webinar only. Please view our CAC meeting web page for specific details and other helpful information.
Novitas seeks your input on establishing pricing under the Medicare program for the 2026 Gapfill laboratory test codes.
Learn why one account is all you ever need.
The February 2026 electronic billing newsletter is now available.
Review our updated article to register for upcoming educational events, listen to recordings of previous WISeR webinars, and access informational model program resources.
Effective January 1, 2026, the application of the JW and JZ modifiers has changed for certain skin substitutes per the calendar year (CY) 2026 final rule. This article describes the changes.
News
CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines
CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs
CMS Proposes Rule to Strengthen Oversight of Organ Procurement Organizations and Protect Patients
CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy & Sustainability
DMEPOS Competitive Bidding: Next Round & FAQs
FY 2025 Medicare Fee-for-Service Improper Payment Rate
Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Compliance
Pneumatic Compression Devices: Prevent Claim Denials
Claims, Pricers & Codes
HCPCS Application Summaries & Coding Determinations: Drugs & Biologicals
Events
Hospital Price Transparency Webinar: Reviewing CY 2026 OPPS & ASC Final Rule Updates – February 11
MLN Matters® Articles
Method II Critical Access Hospital: Professional Billing Requirements for Emergency Department Services
Publications & Multimedia
Medicare Billing: CMS-1450 & 837I – Revised
Medicare Billing: CMS-1500 & 837P – Revised
From Our Federal Partners
New World Screwworm: Outbreak Moves into Northern Mexico
View the most recent updates for our LCDs and articles.
A new article has been added relating to questions and answers relating to the ambulatory surgical center (ASC) prior authorization (PA) demonstration
The National Part A/B MAC Ambulance supplier coalition January 14, 2026, meeting minutes can be viewed via this link.
The MEDPARD is a comprehensive listing of participating providers and suppliers who have agreed to accept assignment on all Medicare covered services. Beneficiaries can use the online directory to locate participating providers, including their names, addresses, phone numbers, and specialties.
2 issues have been identified relating to invalid modifiers and contractor priced codes. Take time to review the information.
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology and other codes claims submissions indicated in this article. Novitas requests specific documentation with submission of these codes. Please note that the other codes list has been updated.
Review updated article for CAR T-cell therapy.
Revised common questions and answers posed during our webinars on the WISeR model prior authorization program.
News
DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment
Compliance
Evaluation and Management Services & Intravitreal Injections: Bill Correctly
Claims, Pricers & Codes
Vagus Nerve Stimulation National Coverage Determination: Removing National Edit for Diagnosis Code G47.33
Events
CCSQ Quarterly Stakeholder Webinar – February 4
Publications & Multimedia
Medicare Wellness Visits — New Webpage
Telehealth & Remote Monitoring – Revised
Patient eligibility and duplicate denials continue to be top claims errors. Review the quarterly claim denials.
Please review the updated list for Ambulatory surgery center (ASC) device codes.
News
Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Providers & Suppliers: CMS Has Authority to Conduct Enrollment Site Visits
Compliance
Remote Patient Monitoring: Use & Bill Correctly
Claims, Pricers & Codes
Integrated Outpatient Code Editor Version 27.0
MLN Matters® Articles
Travel Allowance Fees for Specimen Collection: CY 2026 Updates
Publications & Multimedia
Information for Critical Access Hospitals – Revised
Rural Emergency Hospitals – Revised
Read this article for the CY 2026 update for Travel Allowance for Collection of Specimens.
Our event calendar has been updated and new events are open for registration.
New:
This article is for laboratories, laboratory physicians, and other providers billing MACs for specimen collection services
Review the common questions and answers posed during our webinars on the WISeR model prior authorization program.
News
CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
CMS Announces Establishment of the Office of Rural Health Transformation
New CMS LEAD Model Aims to Expand Access to Accountable Care, Improve Health Outcomes
CMS Proposed Model Test Would Lower Certain Medicare Part B Prescription Drugs
CMS Proposed Model Test Would Lower Drugs Costs for Medicare Part D
CMS BALANCE Model Aims to Expand Access to GLP-1 Medications for People with Medicare Part D & Medicaid
Transparency in Coverage Proposed Rule
Final Local Coverage Determinations for Certain Skin Substitutes Withdrawn
Physicians & Non-Physicians: Comment on Medicare Enrollment Application by February 17
Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Hospitals: Apply for Additional Residency Positions by March 31
Medicare-Funded Physician Residency Positions Awarded
Health Professional Shortage Area: CY 2026 Bonus Payments
Ambulance Fee Schedule: CY 2026 Inflation Factor
Doctors & Clinicians: CY 2023 Performance Information
Information for Critical Access Hospitals
Claims, Pricers & Codes
ICD-10-PCS: CMS Announces 80 New Codes, Effective April 1
Medicare Part B Drug Pricing Files & Revisions: January Update
National Correct Coding Initiative: January Update
Updated ICD-10 Medicare Severity Diagnosis-Related Group Version 43.1
Events
2026 CMS Burden Reduction Conference – February 25
MLN Matters® Articles
Cardiac Contractility Modulation for Heart Failure
Chimeric Antigen Receptor T-Cell Therapy Billing Instructions: Medicare Claims Processing Manual Update
DMEPOS Fee Schedule: CY 2026 Update
ESRD & Acute Kidney Injury Dialysis: CY 2026 Update
National Coverage Determination 20.40: Renal Denervation for Uncontrolled Hypertension
Laboratory National Coverage Determination Edit Software: January 2026 Update
Payment for Medicare Part B Preventive Vaccines & Their Administration for Rural Health Clinics & Federally Qualified Health Centers – Revised
Publications & Multimedia
Medicare Provider Enrollment – Revised
Please review the revised drug codes list.
A new article was created to outline the vaccine reimbursement for 2026.
Add more Novitasphere users with these steps.
View the most recent updates for our LCDs and articles.
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