Transmittals

This transmittal updates Chapter 42, Independent Renal Dialysis Facility Cost Report, Form CMS-265-11, by revising the existing instructions and electronic cost report (ECR) specifications.

Section 2231, Regional Medicare Swing-Bed-Rates, adds Tables 37 and 38 to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar years 2026 and 2027.

Revisions to State Operations Manual (SOM), Appendix R

Implementation of Wasteful and Inappropriate Service Reduction (WISeR) Model Prior Authorization and Medical Review Process and Establishment of New Quarterly Change Request (CR) Process for Possible Future Changes to Information Included in Attachments A, B, C, D, E, and F.

Billing Code Clarification for National Coverage Determination (NCD) 210.13 Screening for Hepatitis C Virus (HCV) in Adults

Calendar Year (CY) 2026 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures

Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update for Calendar Year (CY) 2026

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) – April 2026

National Fee Schedule for Vaccine Administration Quarterly Update - April 2026

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

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

Prior Authorization Data - Add Medicare Beneficiary Identifier (MBI)

Annual Instructions for Downloading the Medicare ZIP Code Files for the Remainder of Calendar Year 2026

File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) Descriptions

Updating Consistency Editing Logic for Provider-Based Department (PBD) Claims Processing

Combined Common Edits/Enhancements Modules (CCEM) Code Set Update

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2026 Update

Update to Claims Processing Instructions for National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)

NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension

NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension