What types of policy changes does Medicare/CMS issue?

Medicare/CMS regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Medicare/CMS update its policies?

Medicare/CMS typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Medicare/CMS policy changes are tracked here?

This page currently tracks 35 documented Medicare/CMS policy changes. New items are added as they are identified.

What should I do when Medicare/CMS changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Medicare/CMS Policy Changes & Prior Auth Updates

We track 35 documented policy changes from Medicare/CMS across FL, KY, LA, ND, NJ and 4 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Medicare/CMS notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Medicare/CMS updates automatically.

Medium impact
2026-06-11 - Medicare Shared Savings Program: Apply by June 23
Medicare/CMS·Effective Aug 3, 2026
Medicare has published multiple updates including deadline reminders for Shared Savings Program applications (due June 23), clinical laboratory data reporting requirements (due July 31), and new Medicare enrollment forms effective August 3. Key billing code updates include adding CPT 87494 for STI screening and CPT 62330 for lumbar decompression procedures.
Medium impact
2026-06-04 - Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees & Boosting Transparency
Medicare/CMS·Effective Jul 1, 2026
CMS finalized major reforms to the No Surprises Act's Federal Independent Dispute Resolution process to make out-of-network payment disputes more efficient and reduce administrative costs. Additionally, Medicare GLP-1 Bridge educational materials were released for the July 1, 2026 program start, and several other updates affecting various specialties.
Medium impact
2026-05-28 - PEPPER Relaunch for All Facility Types: Get Ready Now
Medicare/CMS·Identified May 28, 2026
CMS is relaunching the PEPPER (Program for Evaluating Payment Patterns Electronic Report) tool for all Medicare facility types to help identify billing patterns and potential compliance issues. Healthcare facilities need to ensure authorized staff have access through the CMS Identity & Access System to download and review their organization's billing data reports.
Medium impact
2026-05-21 - Critical Access Hospitals: Download Your FY 2025 PEPPER
Medicare/CMS·Identified May 21, 2026
CMS released FY 2025 PEPPER reports for critical access hospitals to help review billing patterns and identify potential coding issues. A new HCPCS code G0136 was finalized for physical activity and nutrition risk assessments as an add-on to E/M visits or annual wellness visits every 6 months.
Medium impact
2026-05-14 - CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements
Medicare/CMS·Effective May 18, 2026
CMS announces Electronic Prior Authorization Acceleration initiative with 30 healthcare organizations as early adopters to address workflow and technical barriers ahead of 2027 requirements. Bone growth stimulator codes E0747, E0748, and E0760 are reclassified as Class II devices effective May 18, 2026, requiring removal of KF modifier and updated fee schedules.
Medium impact
2026-05-07 - Electronic Prior Authorization Improvements: Get Involved & Start Testing
Medicare/CMS·Effective Jul 1, 2026
CMS is implementing electronic prior authorization improvements and encourages providers to begin testing FHIR API integration with EHR vendors and payers. A new Medicare GLP-1 Bridge demonstration starts July 1, 2026, requiring providers to submit prior authorization requests through a central processor for eligible GLP-1 medications.
Medium impact
2026-05-06 - Moving Prior Authorization into the 21st Century
Medicare/CMS·Identified May 7, 2026
CMS Administrator announces a modernization initiative to streamline prior authorization processes, moving away from fax-based systems to electronic methods. This signals upcoming changes to reduce administrative burden and delays in patient care authorization.
High impact
2026-04-30 - CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices
Medicare/CMS·Effective May 1, 2026
CMS released multiple updates including a new RAPID coverage pathway for breakthrough medical devices, mandatory clinical lab data reporting starting May 1, required third-party vendor enrollment by May 11, new physical activity risk assessment code G0136, and updated abdominal aortic aneurysm screening codes.
Medium impact
2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources
Medicare/CMS·Identified Apr 23, 2026
CMS released new resources for the 2026 Interoperability Standards and Prior Authorization Proposed Rule, with comment period ending June 15. The update includes technical workflows, proposed metrics, and implementation guides for new prior authorization requirements and API standards.
Medium impact
2026-04-15 - Overview of the CMS Interoperability Standards & Prior Authorization for Drugs Proposed Rule Webinar – April 16
Medicare/CMS·Identified Apr 16, 2026
CMS is hosting a webinar on April 16 to discuss a new proposed rule (CMS-0062-P) that would require electronic prior authorization for drugs, improve decision timeliness, and increase transparency in the drug prior authorization process. This is currently a proposed rule being discussed, not yet implemented policy.
High impact
2026-04-16 - CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System
Medicare/CMS·Effective May 11, 2026
CMS launched new digital health tools and requires providers to enroll third-party vendors for Medicare eligibility checking by May 11. Multiple billing updates include new ASC payment codes, hospital billing processes, and therapeutic shoe documentation requirements.
Medium impact
2026-04-13 - Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System Proposed Rule: FY 2027
Medicare/CMS·Effective Oct 1, 2026
CMS proposed a 2.4% increase in Medicare inpatient hospital payment rates for FY 2027, effective October 1, 2026. The rule also proposes new prior authorization timelines for drugs: 24 hours for urgent requests and 72 hours for standard requests, with increased transparency requirements for claim denials.
Medium impact
2026-04-09 - Skilled Nursing Facility Prospective Payment System Proposed Rule: FY 2027
Medicare/CMS·Identified Apr 9, 2026
CMS issued proposed rules for FY 2027 payment updates across multiple post-acute care settings, with SNF rates increasing 2.4%, IRF rates increasing 2.4%, IPF rates increasing 2.3%, and hospice rates increasing 2.4%. These are proposed rules with comments due June 1, 2026, and final rates will be determined later.
Medium impact
2026-04-02 - HHS & CMS Announce Healthcare Advisory Committee Members to Improve Patient Care and Modernize the U.S. Healthcare System
Medicare/CMS·Effective Apr 7, 2026
This MLN Connects newsletter contains multiple updates including OPPS Drug Acquisition Cost Survey deadline extension to April 7, 2026, XPHOZAN drug inclusion in ESRD bundled payment, and billing guidance for E&M services with intravitreal injections. Key billing code changes include status indicator updates and coverage determinations.
High impact
2026-03-26 - CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98M a Year
Medicare/CMS·Effective May 26, 2026
CMS is phasing out fax machines and mail for healthcare transactions, requiring electronic submission of claims attachments and adopting electronic signature standards. This will streamline administrative processes and reduce paperwork burden for providers.
Medium impact
2026-03-19 - CMS Announces Manufacturer Participation in Third Cycle of Medicare Drug Price Negotiation
Medicare/CMS·Effective May 12, 2026
CMS released the March 2026 newsletter announcing multiple Medicare updates including drug price negotiations, form updates, and various program deadlines. Key changes include mandatory use of updated beneficiary notice forms starting May 2026 and several upcoming application deadlines for hospitals and ACOs.
Medium impact
2026-03-12 - CMS Strengthens Patient Protections & Accountability in Organ Donation System
Medicare/CMS·Effective Apr 1, 2026
CMS released a comprehensive newsletter covering multiple policy updates including hospital price transparency enforcement starting April 1, clinical lab reporting requirements beginning May 1, and Quality Payment Program conversion factor corrections affecting physician payments.
Medium impact
2026-03-05 - DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies
Medicare/CMS·Effective Feb 25, 2026
CMS implemented a temporary 6-month nationwide moratorium on new DMEPOS medical supply company enrollments effective February 25, 2026. The moratorium prevents new medical supply companies from enrolling as Medicare providers and may be extended in 6-month increments.
High impact
2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
Medicare/CMS·Effective Jan 1, 2026
CMS announced a major healthcare fraud crackdown including a nationwide moratorium on Medicare enrollment for certain DMEPOS suppliers and enhanced monitoring of MAC MBI lookup tools. Additionally, multiple billing updates are effective including new hypoglossal nerve neurostimulator codes, mandatory electronic CLIA certificates after March 1, and updated therapy service thresholds.
Low impact
2026-02-19 - Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate
Medicare/CMS·Effective Jan 1, 2026
The 2026 payment rate for historically excepted tribal Federally Qualified Health Centers has been set at $733 for medically necessary face-to-face visits. CMS will automatically adjust any claims previously paid at the 2025 rate, requiring no action from billing teams.
Medium impact
2026-02-12 - Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs
Medicare/CMS·Effective Mar 1, 2026
CMS has made several updates including allowing hospital staff to access PEPPER reports, transitioning CLIA certificates to electronic-only format after March 1, 2026, and clarifying billing requirements for global surgery reporting and optometry services at nursing facilities.
Medium impact
2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
Medicare/CMS·Effective Jan 1, 2026
The MLN Connects newsletter for February 5, 2026 announces multiple billing updates including a March 31 deadline for hospitals to submit drug acquisition cost data, elimination of AX modifier requirements for ESRD facilities starting July 2026, and new HCPCS codes for behavioral health integration services effective January 2026.
Medium impact
2026-01-29 - CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines
Medicare/CMS·Effective Mar 1, 2026
CMS issued several policy updates affecting Medicare billing, including new drug price negotiations for 2028, proposed Medicare Advantage payment changes for 2027, and critical compliance reminders. Key immediate actions include switching to electronic CLIA certificates by March 1, 2026, and improving pneumatic compression device billing to reduce the current 61.5% denial rate.
Medium impact
2026-01-22 - DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment
Medicare/CMS·Effective Jan 22, 2026
CMS added 18 new items to the DMEPOS Master List that may require face-to-face encounters, written orders prior to delivery, or prior authorization. This includes 8 new oxygen items, 5 orthoses, and 2 pneumatic compression devices that could impact billing workflows.
Medium impact
2026-01-15 - Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1
Medicare/CMS·Effective Mar 1, 2026
CMS is ending paper fee coupons and CLIA certificates after March 1, 2026, requiring laboratories to switch to electronic notifications and online payment of certification fees. This affects any healthcare practice that performs laboratory testing and needs CLIA certification.
High impact
2025-11-14 - Medicare Participation Announcement for CY 2026: Decide by December 31
Medicare/CMS·Effective Jan 1, 2026
Medicare providers must decide their participation status for 2026 by December 31, 2025. Participating providers receive 5% higher payments than non-participating providers and get paid directly by Medicare.
High impact
2025-11-20 - 2026 Medicare Parts A & B Premiums and Deductibles
Medicare/CMS·Effective Jan 1, 2026
Medicare Part A and B deductibles, coinsurance amounts, and premiums are increasing for 2026. Part A hospital deductible increases to $1,736 (+$60), Part B annual deductible increases to $283 (+$26), and various daily coinsurance rates for hospital stays and skilled nursing facilities are also rising.
High impact
2025-11-21 - Update on Processing of Medicare Claims Impacted During the Government Shutdown
Medicare/CMS·Effective Oct 1, 2025
Congressional action retroactively restored Medicare telehealth payment provisions effective October 1, 2025 through January 30, 2026. Previously returned telehealth claims can now be resubmitted, and the requirement to use GY modifiers on certain telehealth claims has been rescinded.
High impact
2025-11-24 - CMS Empowers Patients and Boosts Transparency by Modernizing Hospital Payments
Medicare/CMS·Effective Jan 1, 2026
CMS has released the CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule, which modernizes hospital payments and enhances price transparency for Medicare beneficiaries. This rule introduces patient-focused reforms affecting hospital outpatient and ASC billing starting in 2026.
Medium impact
2025-11-26 - Medicare Participating Physician or Supplier Agreement Form Expires on November 30
Medicare/CMS·Effective Jan 1, 2026
The Medicare Participating Physician or Supplier Agreement Form CMS-460 expires on November 30, 2025, but Medicare Administrative Contractors will continue accepting the current version while it undergoes OMB review. Additionally, new telehealth services codes G0660-G0668 will be available starting January 1, 2026 for qualifying episodes under the Transforming Episode Accountability Model.
Medium impact
2025-12-03 - 2026 Medicare Participation Announcement
Medicare/CMS·Effective Jan 1, 2026
CMS announced the 2026 Medicare Participation updates with key focus on reducing administrative burden and improving program integrity. Home Health agencies will see an aggregate 1.3% decrease ($220 million) in Medicare payments for 2026 due to various adjustment factors despite a 2.4% base rate increase.
High impact
2025-12-04 - Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details
Medicare/CMS·Effective Jan 1, 2026
CMS is launching a mandatory OPPS Drug Acquisition Cost Survey from January 1 - March 31, 2026, requiring hospitals that received OPPS payments for outpatient drugs from July 1, 2024 - June 30, 2025 to report drug acquisition costs. The survey aims to inform CY 2027 payment policy changes for hospital outpatient departments.
Medium impact
2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity
Medicare/CMS·Effective Jan 1, 2026
CMS has finalized new DMEPOS accreditation provisions to enhance program integrity, with multiple payment rate updates and billing changes effective January 1, 2026. Key changes include new institutional provider enrollment fees of $750, updated payment rates for various services, and new billing requirements for critical access hospitals.
Medium impact
2025-12-18 - MAHA ELEVATE Brings Lifestyle Medicine to Original Medicare
Medicare/CMS·Effective Sep 1, 2026
CMS announced the MAHA ELEVATE Model, a voluntary program funding up to 30 chronic disease prevention and lifestyle medicine programs starting September 2026. This newsletter also includes multiple other Medicare updates including drug survey requirements, billing code changes, and compliance tips.
Medium impact
2026-01-08 - CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
Medicare/CMS·Identified Jan 12, 2026
CMS announces $50 billion Rural Health Transformation Program providing awards to all 50 states, establishes new Office of Rural Health Transformation, and introduces new ACO models (LEAD, GLOBE, GUARD, BALANCE) targeting rural providers and prescription drug costs. Multiple new models launching between 2026-2027 with applications opening in Spring 2026.

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2026-06-11 - Medicare Shared Savings Program: Apply by June 23

2026-06-04 - Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees & Boosting Transparency

2026-05-28 - PEPPER Relaunch for All Facility Types: Get Ready Now

2026-05-21 - Critical Access Hospitals: Download Your FY 2025 PEPPER

2026-05-14 - CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements

2026-05-07 - Electronic Prior Authorization Improvements: Get Involved & Start Testing

2026-05-06 - Moving Prior Authorization into the 21st Century

2026-04-30 - CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices

2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources

2026-04-15 - Overview of the CMS Interoperability Standards & Prior Authorization for Drugs Proposed Rule Webinar – April 16

2026-04-16 - CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System

2026-04-13 - Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System Proposed Rule: FY 2027

2026-04-09 - Skilled Nursing Facility Prospective Payment System Proposed Rule: FY 2027

2026-04-02 - HHS & CMS Announce Healthcare Advisory Committee Members to Improve Patient Care and Modernize the U.S. Healthcare System

2026-03-26 - CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98M a Year

2026-03-19 - CMS Announces Manufacturer Participation in Third Cycle of Medicare Drug Price Negotiation

2026-03-12 - CMS Strengthens Patient Protections & Accountability in Organ Donation System

2026-03-05 - DMEPOS: Temporary Enrollment Moratorium on Medical Supply Companies

2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud

2026-02-19 - Historically Excepted Tribal Federally Qualified Health Centers: CY 2026 Payment Rate

2026-02-12 - Short-Term Acute Care Hospitals: Staff End Users Can Now Access PEPPERs

2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31

2026-01-29 - CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines

2026-01-22 - DMEPOS: Updated List of Items Potentially Subject to Conditions of Payment

2026-01-15 - Laboratories: Paper Fee Coupons & CLIA Certificates Ending March 1

2025-11-14 - Medicare Participation Announcement for CY 2026: Decide by December 31

2025-11-20 - 2026 Medicare Parts A & B Premiums and Deductibles

2025-11-21 - Update on Processing of Medicare Claims Impacted During the Government Shutdown

2025-11-24 - CMS Empowers Patients and Boosts Transparency by Modernizing Hospital Payments

2025-11-26 - Medicare Participating Physician or Supplier Agreement Form Expires on November 30

2025-12-03 - 2026 Medicare Participation Announcement

2025-12-04 - Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1: Get Key Dates & Details

2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity

2025-12-18 - MAHA ELEVATE Brings Lifestyle Medicine to Original Medicare

2026-01-08 - CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States