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2020 (April)
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OPPS Fee Schedule

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CMS Transmittals




Webinar: 2020 Regulatory Update: Hospital Outreach Programs Wednesday, June 17, 2020

Issue DateTransmittalTitleImplementation Date
2020-06-05 R10168CP

July Quarterly Update for 2020 Durable Medical Equipment,…

2020-07-06
2020-06-05 R10167CP

Quarterly Update for the Temporary Gap Period of the Durable…

2020-10-05
2020-06-05 R10166CP 2020-07-01 11814
2020-05-22 R10147MSP Update the International Classification of Diseases, Tenth Revision (… 2020-10-05
2020-05-27 R10162OTN

COBOL Version 6.2 Upgrade - Additional Analysis and Phase I…

2020-10-05
2020-05-26 R10161OTN

Therapy Codes Update

2020-06-16
2020-05-22 R10145NCD

National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (…

2020-06-23
2020-05-22 R10154CP

National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (…

2020-10-05
2020-05-22 R10153CP

October 2020 Healthcare Common Procedure Coding System (HCPCS)…

2020-10-05
R10151CP

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

2020-10-05
2020-05-22 R10045NCD

National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (…

2020-06-23
2020-05-22 R10146PI

Implementation of Provider Enrollment Provisions in CMS-6058-FC…

2020-07-24
2020-05-22 R10148CP

Claim Status Category Codes and Claim Status Codes Update

2020-10-05
2020-05-22 R10149CP

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (…

2020-10-05
2020-05-22 R10150CP

Implement Operating Rules - Phase III Electronic Remittance Advice (…

2020-10-05
2020-05-22 R10160OTN

Summary of Policies in the Calendar Year (CY) 2020 Medicare Physician…

2020-06-12
SE20018 COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals
SE20019 Medicare Continues to Modernize Payment Software
SE20017 Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing
SE20008 Medicare Clarifies Recognition of Interstate License Compacts
SE20016 New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE)
SE20015 New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act
SE20012 Supplier Education on Use of Upgrades for Multi-Function Ventilators
SE20011 Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)
SE20010 Ensure Required Patient Assessment Information for Home Health Claims
SE20009 Section 1876 and 1833 Cost Plan Enrollee Access to Care through Original Medicare
SE20006 NCD 20.4 Implantable Cardiac Defibrillators (ICDs)
SE20007 Standard Elements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order, and Master List of DMEPOS Items Potentially Subject to a Face-to-Face Encounter and Written Orders Prior to Delivery and, or Prior Authorization Requirements
SE20005 The Role of Therapy under the Home Health Patient-Driven Groupings Model (PDGM)
SE20001 Incorrect Billing of HCPCS L8679 - Implantable Neurostimulator, Pulse Generator, Any Type
SE20004 Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked Questions
SE20003 Medicare Fee-for-Service (FFS) Response to the 2010 Commonwealth of Puerto Rico Earthquakes
2020-01-10 R265BP Manual Updates Related to Calendar Year (CY) 2020 Home Health Payment Policy Changes, Maintenance Therapy, and Remote Patient Monitoring 2020-02-11
2020-01-10 SE20002 Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging- Approval of Using the K3 Segment for Institutional Claims
2020-01-10 R933PI Update to Chapter 3, Section 3.2.3.1 Additional Documentation Requests (ADR) of Publication (Pub) 100-08 2020-01-06
2020-01-09 R4491CP Updates to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) 2020-04-06
2020-01-09 R4489CP Home Health (HH) Patient-Driven Groupings Model (PDGM) - Split Implementation 2019-07-01
2020-01-08 R2416OTN User CR: ViPS Medicare System (VMS) - Increase Edit Code Maximum 2020-04-06
2020-01-03 R2413OTN New State Codes for California, Kentucky and West Virginia 2020-04-06
2020-01-03 R2415OTN Updates to Bills Pending Report for the Fiscal Intermediary Shared System (FISS) 2020-04-06
2020-01-03 R2414OTN ViPS Medicare System (VMS) Online and Print Reporting of Automated Claims Examination System (ACES) Statistics 2020-04-06
2020-01-03 R4487CP CY 2020 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule 2020-01-06
2020-01-03 R2413OTN New State Codes for California, Kentucky and West Virginia 2020-04-06
2019-11-15 R481PR1 provides for calendar year (CY) inflation factors to update previous years’ reasonable compensation ranges. The factor is from the cost category Professional Fees: Labor Related in the CMS Prospective Payment System Hospital Input Price Index. N/A
2019-11-15 R482PR1 Adjusted Hourly Salary Equivalency Amount Monthly Inflation Factors For Critical Access Hospitals (CAH) and CAHs With Swing Beds, provides inflation factors to be applied to the published April 10, 1998. N/A
2019-11-15 R4465CP Medicare Claims Processing Manual Chapter 23 - Fee Schedule Administration and Coding Requirements 2020-01-30
2019-11-15 R4464CP Instructions for Retrieving the 2020 Pricing and Healthcare Common Procedure Coding System (HCPCS) Data Files through CMS' Mainframe Telecommunications Systems 2020-01-06
2019-11-15 R2397OTN 2020-04-06 11234
2019-11-15 R4463CP 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 2020-04-06
2019-11-15 R4462CP Instructions for Downloading the Medicare ZIP Code Files for April 2020 2020-04-06
2019-11-15 R4461CP Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update 2020-04-06
2019-11-15 R4460CP Claim Status Category and Claim Status Codes Update 2020-04-06
2019-11-15 R924PI Updates to the Medical Review Instructions Related to Skilled Nursing Facilities (SNF) 2019-12-17
2019-11-15 R2396OTN Create a New Standalone Health Insurance Master Record (HIMR) Application - Analysis Only 2020-04-06
2019-11-15 R2395OTN Implementation to Accept Document Codes and Include Appropriate Document Code(s) in the Pre-Pay Electronic Medical Documentation Requests (eMDR) to Participating Providers, via the Electronic Submission of Medical Documentation (esMD) System N/A
2019-11-15 R195SOMA Revisions to State Operations Manual (SOM) Chapter 6 - Special Procedures for Laboratories and Chapter 9 Exhibits 2019-11-15
2019-11-15 R4456CP Combined Common Edits/Enhancements Modules (CCEM) Code Set Update 2020-04-06
2019-11-15 R331FM The Fiscal Year 2020 Updates for the CMS Internet Only Manual (IOM) Publication (Pub.) 100-06, Medicare Financial Management Manual, Chapter 7 - Internal Control Requirements 2019-12-17
2019-11-15 R2393OTN Mobile Personal Identity Verification (PIV) Station Installation 2019-12-02
2019-11-15 R2394OTN Updating Fiscal Intermediary Shared System (FISS) Editing for Practice Locations to Bypass Mobile Facility and/or Portable Units and Services Rendered in the Patient's Home 2020-04-06
2019-11-08 R2392OTN Refinement of the Transitional Drug Add-on Payment Adjustment (TDAPA) 2020-04-06
2019-11-07 R4455CP Calendar Year (CY) 2020 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures N/A
2019-10-25 R4419CP 2020 Annual Update of Per-Beneficiary Threshold Amounts 2020-01-06
2019-11-01 R4440CP New Modifiers to Identify Occupational Therapy (OT) and Physical Therapy (PT) Services Provided by a Therapy Assistant 2020-01-06
2019-10-18 R4418CP Medicare Physician Fee Schedule Database (MPFSDB) Update to Status Indicators 2019-11-19
2019-10-04 R4408CP Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2020 2020-01-06
2019-10-25 R4421CP 2020 Annual Update to the Therapy Code List 2020-01-06
2019-11-08 R2389OTN User CR: ViPS Medicare System (VMS) Increase Number of SuperOp Occurrences within a Value Set 2020-04-06
2019-11-08 R4454CP Updates to the Coordination of Benefits Agreement Insurance File (COIF) For Use in the National Coordination of Benefits Agreement (COBA) Crossover Process 2020-04-06
2019-11-08 R4453CP Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2020 2020-01-06
2019-11-08 R4452CP Home Health (HH) Patient-Driven Groupings Model (PDGM) - Revised and Additional Manual Instructions 2019-12-11
2019-11-08 R2387OTN Positron Emission Tomography (PET) Scan - Allow Tracer Codes Q9982 and Q9983 in the Fiscal Intermediary Shared System (FISS) 2020-04-06
2019-11-08 R262BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2020 2020-01-06
2019-11-08 R2384OTN User CR: ViPS Medicare System (VMS) - Increase Edit Code Maximum 2020-04-06
2019-11-08 R2390OTN Enhance Maximum Claim Counter for Edits and Audits - Implementation N/A
2019-11-08 R2386OTN ViPS Medicare System (VMS) Online and Print Reporting of Automated Claims Examination System (ACES) Statistics 2020-04-06
2019-11-08 R2385OTN Medicare Shared Savings Program (SSP) Skilled Nursing Facility (SNF) Affiliates' Updated Qualifying Stay Edits 2020-04-06
2019-11-08 R2383OTN User Change Request: Fiscal Intermediary Shared System (FISS) - Hook Option for National Provider Identifier (NPI) Does Not Select Claims 2020-04-06
2019-11-06 R330FM The Medicare Fee-for-Service Recovery Audit Program 2019-11-04
2019-11-06 R921PI The Medicare Fee-for-Service Recovery Audit Program 2019-11-04
2019-11-04 R233DEMO Display PARHM Claim Payment Amounts 2020-01-06
2019-11-04 R4443CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2019 Update 2019-10-07
2019-11-01 R2382OTN International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)--April 2020 Update 2020-04-06
2019-11-01 CMS-1715-F CMS-1715-F 2019-11-15
20196-11-01 R128GI Internet Only Manual (IOM) - Update to General Information, Eligibility, and Entitlement, Chapter 7 - Contract Administrative Requirements, Section 40.2 – Shared System Maintainer Responsibilities for Systems Releases 2019-12-03
2019-11-01 R2379OTN Updates to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) 2020-04-06
2019-11-01 R2380OTN Editing Update for Vaccine Services 2020-04-06
2019-11-01 R2377OTN User Change Request: Analysis for Medicare Summary Notices (MSNs) without Beneficiary Address after Finalist 2019-12-03
2019-11-01 R4431CP Health Professional Shortage Area (HPSA) Bonus Payments for All Mental Health Specialties 2020-02-04
2019-10-29 R4424CP Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2020 2020-01-06
2019-10-25 R4422CP Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 26.0, Effective January 1, 2020 2020-01-06
2019-10-25 R194SOMA Revisions to State Operations Manual (SOM) Appendix G, Guidance for Surveyors: Rural Health Clinics 2019-10-25
2019-10-23 R2376OTN User CR: MCS - Updates to Beneficiary Deliverable Logic for Internal/Clerk Duplicate Medicare Summary Notices (MSNs) and Temporary Addresses 2020-01-06
2019-10-21 R230DEMO Next Generation and Vermont ACO Model - AIPBP Reduction File and BE Modifications 2020-01-06
2019-10-18 R328FM Updates to Medicare Financial Management Manual Chapter 4, Section 50-50.6 Extended Repayment Schedules 2019-10-07
2019-10-18 11463 Medicare Administrative Contractor (MAC) Verification of Potential Errors and Corrective Actions Taken 2019-11-19
2019-10-18 R2375OTN Advanced Provider Screening (APS) Phase 2 Go-Live 2019-11-18
2019-10-18 R2374OTN Updating Calendar Year (CY) 2020 Medicare Diabetes Prevention Program (MDPP) Payment Rates 2020-01-06
2019-10-17 R480PRI To update the language in the initial paragraph of this section and adds Table 31 to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2020. N/A
2019-10-11 R327FM Notice of New Interest Rate for Medicare Overpayments and Underpayments -1st Qtr Notification for FY 2020 2019-10-18