Transmittals

April 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)

This purpose of this Change Request (CR) is to establish a quarterly recurring update, provide instructions for MCS system changes required to automate the AOC File retrieval as well as establish standardized MCS auditing for claims processing.

April Quarterly Update for 2026 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

July 2026 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

Update to the Internet Only Manual (IOM) Publication 100-04, Chapter 18, Sections 210- 210.4 in Reference to Change Request (CR) 14388 “Billing Code Clarification for National Coverage Determination (NCD) 210.13 Screening for Hepatitis C Virus (HCV) in Adults”

Claims Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), Medicare Remit Easy Print (MREP), and PC Print Update

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.2, Effective July 1, 2026

July 2026 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

Implementation CR - Send Transplant Program Hospital Type and the New Organ Types to the Fiscal Intermediary Shared System (FISS) on Provider Enrollment Chain & Ownership System (PECOS) Extract Files and for FISS to Process so PECOS is the system of Record for the Transplant Program Hospital Type and for the Organs Type Transplanted at the Hospital

Technical Corrections to the State Operations Manual (SOM) Appendix A - Hospitals

NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension

NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension

Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18, Section 110.3.2, to Align with Medicare Preventive Services for Ultrasound Abdominal Aortic Aneurysm (AAA) Screening

Face-to-Face Encounter Requirements for Replacements Occurring After the Reasonable Use Lifetime (RUL)

Upload of Hospice Aggregate Cap Determination Letters and Hospice Filed Self-Determined Hospice Cap Documentation into the System for Tracking Audit and Reimbursement (STAR)

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Stay of Enrollment

April 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Provider Education for the Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility Services (IRFs)

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year (FY) 2024 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)

Internet-Only Manual Update, Pub. 100-04, Chapter 18 (Preventive and Screening Services), Section 10.2.1