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Laboratory Fee Schedule

2018

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2018

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2018

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2018

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2018

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2018

ASP Drug Pricing Files

October 2018
July 2018


CMS Transmittals



Issue DateTransmittalTitleImplementation Date
2018-10-19 R15P240 Provider Reimbursement Manual Part 2, Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10 2018-10-19
2018-10-19 R4147CP Magnetic Resonance Imaging (MRI) 2018-12-10
2018-10-19 R208NCD Magnetic Resonance Imaging (MRI) 2018-12-10
2018-10-19 R836PI Medical Review of Diagnostic Laboratory Tests 2018-11-21
2018-10-17 R184SOMA Revisions to State Operations Manual, Chapter 2, Certification Process 2018-10-17
2018-10-11 R2152OTN Procedures for Shared Systems to Handle Foreign (non US) Addresses 2019-01-07
2018-10-12 R2151OTN Updating Calendar Year (CY) 2019 Medicare Diabetes Prevention Program (MDPP) Payment Rates 2019-01-07
2018-10-12 R834PI Order Requirements When Prescribing Practitioner is Also the Supplier and is Permitted to Furnish Specific Items of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) N/A
2018-10-12 R833PI Templates in Medical Review 2018-11-13
2018-10-12 R835PI One-on-One Education 2018-11-13
2018-10-12 R183SOMA Revisions to Medicare State Operations Manual (SOM) Table of Contents, Medicare SOM Appendix, SOM Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, SOM Appendix T- Regulations and Interpretive Guidelines for Swing Beds in Hospitals, SOM Appendix W- Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs) and Swing-Beds in CAHs. 2018-10-12
2018-10-11 R307FM Notice of New Interest Rate for Medicare Overpayments and Underpayments -1st Qtr Notification for FY 2019 2018-10-17
2018-10-05 R210DEMO Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement 2019-01-07
2018-10-04 R4144CP Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes 2018-10-01
2018-10-05 R2148OTN Claim Based Incentive Programs - Non-Assigned Claim Update 2019-04-01
2018-10-05 R832PI Modification to Chapter 6, Section 6.3 (Medical Review of Certification and Recertification of Residents in SNFs) of Publication (Pub.) 100-08 2018-11-06
2018-10-05 R2147OTN Update to the Long Description for Spanish Records on The Procedure Descriptor Master File for all Adds and Updates That Were Not Loaded with Change Request (CR) 10286 N/A
2018-10-05 R2146OTN Update to Common Working File (CWF) Benefit Period Logic for Occurrence Code 22 on Skilled Nursing Facility (SNF) and Swing Bed Inpatient Claims 2019-04-01
2018-10-05 R4143CP 2019 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update 2019-01-07
2018-10-05 R2145OTN Shared System Enhancement 2018: Implementation of the Medicare Summary Notice (MSN) Zip Code Analyzer Tool 2019-04-01
2018-10-03 R829PI Local Coverage Determinations (LCDs) 2019-01-07
2018-10-01 R2144OTN User CR: FISS to Add Location/Statuses to the 6H File Fix 2019-01-07
2018-10-01 R831PI Update to Exhibit 16 - Model Payment Suspension Letters in Publication (Pub.) 100-08 2018-10-01
2018-09-28 R4142CP 2019 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments 2019-01-07
2018-09-27 R4141CP Quarterly Influenza Virus Vaccine Code Update - January 2019 2019-01-07
2018-09-28 R2143OTN Implementation of the Award for the Jurisdiction F (J-F) Part A and Part B Medicare Administrative Contractor (JF A/B MAC) N/A
2018-09-28 R4138CP Confirmation of Pickle Hospital Status 2018-10-18
2018-09-28 R4139CP Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2019 2019-01-07
2018-09-28 R4140CP Updates to Chapter 1 Payer Only Codes in the Medicare Claims Processing Manual 2018-10-29
2018-09-28 R8285PI Guidance Regarding the Use of Statistical Sampling for Overpayment Estimation 2019-01-02
2018-09-28 R182SOMA Revisions to State Operation Manual (SOM), Appendix B - Guidance to Surveyors for Home Health Agencies 2018-09-28
2018-09-28 R478PR1 Table 30 to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2019. These rates should be used to carve out swing-bed costs on the hospital cost report. N/A
2018-09-21 R2141OTN Implementing the Insertion of a Sheet of Paper Promoting the Electronic Medicare Summary Notices (eMSNs) into Mailed Medicare Summary Notices (MSNs) 2019-01-02
2018-09-21 R827PI Updates to Chapter 4 of Publication (Pub.) 100-08 2018-10-22
2018-09-21 R826PI Update to Chapter 4, Section 4.18.1.4 and Exhibit 16 in Publication (Pub.) 100-08 2018-10-22
2018-09-21 R825PI Credentials of Reviewers (This Change Request (CR) Rescinds and Fully Replaces CR 10157.) 2018-10-22
2018-09-21 R4137CP New Waived Tests 2019-01-07
2018-09-20 R2140OTN Redesign of Flu Vaccines in Fiscal Intermediary Shared System (FISS) N/A
2018-09-21 R181SOMA Revisions to State Operations Manual, Chapter 2, Certification Process 2018-09-21
2018-09-14 R2139OTN Monthly Status Report (MSR) Excel Data Template Updates and Implementation of Medicare Administrative Contractor (MAC)/Centers for Medicare & Medicaid Services (CMS) Data Exchange (MDX) Portal System - This CR Rescinds and Fully Replaces CR 10399. N/A
2018-09-13 R4134CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2018 Update 2018-10-01
2018-09-14 R4132CP Instructions for Retrieving the January 2019 Medicare Physician Fee Schedule Database (MPFSDB) Files Through the CMS Mainframe Telecommunications System 2019-01-07
2018-09-14 R4131CP Updates to Chapter 23 Fee File Instructions 2018-12-17
2018-09-14 R4130CP Update to the Medicare Claims Processing Manual, Chapter 23, Section 60.3 2018-10-15
2018-09-14 R246BP Manual Updates Related to Payment Policy Changes Affecting the Hospice Aggregate Cap Calculation and the Designation of Hospice Attending Physicians 2018-12-17
2018-09-11 R2138OTN International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) N/A
2018-09-07 R4128CP Annual Clotting Factor Furnishing Fee Update 2019 2019-01-07
2018-09-06 R2137OTN National Correct Coding Initiative (NCCI) Add-on Codes for Non-Outpatient Prospective Payment System (OPPS) Institutional Providers Implementation 2018-04-02
2018-09-05 R2136OTN Standardization of Case File Transmittal and Provider Information Processes, Bankruptcy, Payment Hold, and Cancellation Reporting Between the Medicare Administrative Contractors (MAC) and the Recovery Audit Contractor (RAC) 2018-10-01
2018-09-05 R4127CP Quarterly Influenza Virus Vaccine Code Update - January 2019 2019-01-07
2018-09-05 R824PI Update to Chapter 15 of Publication (Pub.) 100-08, Certification Statement Policies 2018-10-01
2018-09-04 SE18012 Reminder on Billing Requirements Implemented for non-OPPS Providers SE18012
2018-08-31 R2135OTN Medicare Appeals System (MAS) Part B and Durable Medical Equipment (DME) Data Collection Web Services Pilot 2018-10-01
2018-08-31 R4125CP October 2018 Update of the Ambulatory Surgical Center (ASC) Payment System 2018-10-01
2018-08-31 R4124CP Influenza Vaccine Payment Allowances - Annual Update for 2018-2019 Season 2018-11-01
2018-08-31 R823PI Update to Exhibit 16 - Model Payment Suspension Letters in Publication (Pub.) 100-08 2018-10-01
2018-08-31 R124MSP Updates to Chapters 5 and 6 of Publication 100-05 to Further Clarify Medicare Secondary Payer (MSP) Processes that Include Electronic Correspondence Referral System (ECRS) Requests Submissions and Timely Submission of MSP I Records, General Inquiries and Hospital Reviews 2018-10-01
2018-08-28 R205DEMO Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement 2019-01-07
2018-08-24 R822PI Update to Chapter 15 of Publication (Pub.) 100-08, Certification Statement Policies 2018-10-01
2018-08-24 R4123CP October 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) 2018-10-01
2018-08-24 R4122CP October 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.3 2018-10-01
2018-08-24 R4115CP Claim Status Category and Claim Status Codes Update 2019-01-07
2018-08-24 R4116CP Healthcare Provider Taxonomy Codes (HPTCs) October 2018 Code Set Update N/A
2018-08-24 R4117CP 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 2019-01-07
2018-08-24 R4118CP Combined Common Edits/Enhancements Modules (CCEM) Code Set Update 2019-01-07
2018-08-24 R4120CP Instructions for Downloading the Medicare ZIP Code File for January 2019 2019-01-07
2018-08-24 R4121CP 2019 Healthcare Common Procedure Coding System (HCPCS) Annual Update Reminder 2019-01-07
2018-08-24 R180SOMA Revisions to the State Operations Manual (SOM) Appendix Y, Organ Procurement Organization (OPO) Interpretive Guidance 2018-08-24
2018-08-23 R2134OTN Shared System Enhancement 2015: Resolve Operating Report (ORPT) Issues - Development and Implementation 2020-01-06
2018-08-17 R2132OTN User CR: MCS - Enhance H9 Screen to Hold Information After Claim Finalizes 2019-01-07
2018-08-17 R2133OTN Clarification of Policies Related to Reasonable Cost Payment for Nursing and Allied Health Education Programs 2018-11-19
2018-08-17 R2131OTN Ensuring Home Health Standardized Amounts Are Reflected in the National Claims History 2019-01-07
2018-08-17 R122MSP Electronic Correspondence Referral System (ECRS) Enhanced Functionality 2018-09-17
2018-08-17 R123MSP Updating Language to Clarify for Providers Chapter 3, Section 20 and Chapter 5, Section 70 of the Medicare Secondary Payer Manual 2018-11-20
2018-08-17 R819PI Adding a Targeted Probe and Educate (TPE) Sub-Section Into Section 3.2 of Chapter 3 in Publication (Pub.) 100-08 2018-09-17
2018-08-17 R817PI New Instructions for Home Health Agency Misuse of Requests for Anticipated Payments (RAPs) 2018-09-17
2018-08-16 SE18011 Current Medicare Coverage of Diabetes Supplies SE18011
2018-08-14 R2130OTN Enhancement for Undeliverable Pay Medicare Summary Notices (MSNs) for Multi-Carrier System (MCS) Users 2019-01-07
2018-08-10 R4086CP Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2019 2018-10-01
2018-08-10 R2122OTN International Code of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) N/A
2018-08-10 R2126OTN User CR: FISS to Add Location/Statuses to the 6H File Fix 2019-01-07
2018-08-10 R2120OTN 2019-01-07 10813
2018-08-10 R2125OTN Medicare Diabetes Prevention Program (MDPP) Service Period Change from 3 Years to 2 Years N/A
2018-08-10 R4114CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2018 Upda 2018-10-01
2018-08-10 R4108CP October Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule 2018-10-01
2018-08-10 R2116OTN Modifications to the National Coordination of Benefits Agreement (COBA) Medicare Crossover Process 2019-01-07
2018-08-10 R2119OTN Process Improvement for Recovery Audit Contractor (RAC) Mass Adjustment Input File – Underpayment Adjustment Enhancement 2019-01-07
2018-08-09 R2115OTN 2019-01-07 10811
2018-08-10 R203DEMO Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement 2019-01-07
2018-08-10 R2113OTN Combined Common Edits/Enhancements Module (CCEM) Updates for JAVA (version 6) to JAVA (version 7) 2019-01-07
2018-08-10 R2111OTN Modifications Within Common Working File (CWF) to Adjustment Claims Exceeding Annual Therapy Threshold 2019-01-07
2018-08-10 R2112OTN User CR: FISS to Add Additional Search Features to Provider Direct Data Entry (DDE) Screen 2019-01-07
2018-08-10 R78QRI Payments to Home Health Agencies That Do Not Submit Required Quality Data - This CR Rescinds and Fully Replaces CR 9651. 2018-09-11
2018-08-10 R4111CP Revisions to Medicare Claims Processing Manual for Foreign, Emergency and Shipboard Claims 2018-09-11
2018-08-10 R4109CP Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2018 Update 2018-10-01
2018-08-07 SE18010 Inclusion of Power Mobility Device Codes in the Prior Authorization Program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items SE18010
2018-08-03 R4105CP System Changes to Implement Epoetin Alfa Biosimilar, Retacrit for End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI) Claims 2019-01-07
2018-08-03 R4107CP October 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files 2018-10-01
2018-08-03 R245BP System Changes to Implement Epoetin Alfa Biosimilar, Retacrit for End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI) Claims 2019-01-07
2018-08-03 R2108OTN Shared System Enhancement 2015: Identify Inactive Medicare Demonstration Projects within the Fiscal Intermediary Shared System - (Removing /Archiving demonstration codes 44 and 47) 2019-01-07