Transmittals

Update to the All-Inclusive Rate (AIR) Add-On Payment for High-Cost Drugs Provided by Indian Health Service (IHS) and Tribal Hospitals

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

April 2025 Update of the Ambulatory Surgical Center (ASC) Payment System

Instructions for Downloading the Medicare ZIP Code File for July 2025 Files

This transmittal updates Chapter 41, Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Reports, Form CMS-2540-10 to clarify or revise the following and sunset the form set:

Revisions to State Operations Manual (SOM), Appendix PP

April 2025 Integrated Outpatient Code Editor (I/OCE) Specifications Version 26.1

January 2025 Integrated Outpatient Code Editor (I/OCE) Specifications Version 26.0

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

Modifying Editing for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) Hospice Physician Services When the Beneficiary has Medicare Advantage

New Edit Implementation for Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) for Point of Origin (PoO) Admission or Visit Code “D” Related to the Emergency Department (ED) Adjustment Policy

Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process

Update to the List of Advanced Life Support, Level 2 (ALS2) Procedures in Chapter 10, Ambulance Services, Section 30.1.1, Definition of Ground Ambulance Services

Internet Only Manual (IOM) Update, Publication (Pub.) 100-01, Chapter 7, 40.2 - General Information, Eligibility, and Entitlement Manual Chapter 7 - Contract Administrative Requirements

July 2025 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

Update End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model Change Requests (CRs) to Exclude Acute Kidney Injury (AKI)

Create a New Adjustment Reason Code for Adjustments Created When the Provider Didn't Respond to an Additional Documentation Request (ADR)

End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model Demo Priorities - Additional Updates

Instructions for Downloading the Medicare ZIP Code File for April 2025 Files

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