Transmittals

Patient Driven Payment Model (PDPM) Corrections to Interrupted Stay Edits to Include Prospective Payment System (PPS) Swing Bed Providers.

NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)

NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)

Implement 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 Healthcare (CAQH) CORE

October 2025 Update of the Hospital Outpatient Prospective Payment System (OPPS)

2026 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update

Revised Start Date of the Expanded Outlier Reconciliation Criteria for the Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS

October 2025 Update of the Ambulatory Surgical Center [ASC] Payment System

Update to Pub 100-04, Chapter 18 - Preventive and Screening Services

Provider Enrollment Updates to Chapter 10 of CMS Publication (Pub.) 100-08, Program Integrity Manual (PIM)

This transmittal updates Chapter 46, Rural Health Clinic (RHC) Cost Report, Form CMS-222-17, by clarifying the existing instructions, forms, and electronic cost report (ECR) specifications.

This transmittal updates Chapter 45, Community Mental Health Center Cost Report, Form CMS-2088-17, by revising instructions, worksheets, and electronic cost report (ECR) specifications.

Update to Medical Review Instructions for Inpatient Hospital Claims in Chapter 6 of Publication (Pub.) 100-08, Program Integrity Manual (PIM)

Revisions to Appendix C-Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services-Advance Copy

Revisions to State Operations Manual (SOM) Chapter 5 - Complaint Procedures, Sections 5500-5590.

Laboratory Specimen Collection Travel Allowance Billing to the Tenth of a Mile

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—January 2026 Update—CR 2 of 2

October Quarterly Update for 2025 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

Enhancing MCS 276/277 Claim Status Processing to Include Medicare Adjudication Portal (MAP) Claims

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2025 Update