Latest updates

This edition includes information on hospital OPPS & home health proposed payment rules, GLP-1 bridge, and more.

Pricing information is now available for new HCPCS codes payable under Medicare when furnished for the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.

The drug codes list and radiopharmaceutical codes lists have been updated.

This edition includes information on the PEPPER relaunch, understanding the telehealth enrollment guide, preventing claim denials for tracheostomy supplies, and more.

This edition includes information on the PEPPER relaunch, understanding the telehealth enrollment guide, preventing claim denials for tracheostomy supplies, and more.

Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code 34554 if modifier ER, PO, or PN is billed on all service lines, and…

There will be Common Working File (CWF) "dark days" Thursday, July 2, through Sunday, July 5, affecting the IVR.

Read this clarification regarding how radiopharmaceutical payment limits should be interpreted and how providers are expected to bill for these items.

There will be Common Working File (CWF) "dark days" Thursday, July 2, through Sunday, July 5, affecting the IVR.

This edition includes information on the 2026 National Provider Compliance Conference, services for patients with opioid use disorder, PEPPER updates, and more.