What types of policy changes does Medicare/CMS - Transmittals issue?

Medicare/CMS - Transmittals 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 - Transmittals update its policies?

Medicare/CMS - Transmittals 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 - Transmittals policy changes are tracked here?

This page currently tracks 30 documented Medicare/CMS - Transmittals policy changes. New items are added as they are identified.

What should I do when Medicare/CMS - Transmittals 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 - Transmittals Policy Changes & Prior Auth Updates

We track 30 documented policy changes from Medicare/CMS - Transmittals. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Medicare/CMS - Transmittals 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 - Transmittals updates automatically.

Low impact
R13784CP: October 2026 Healthcare Common Procedure Coding System (HCPCS) Quarterly Update Reminder
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM), including help desks, websites, and tools for registration, training, and consumer assistance. Despite the title mentioning HCPCS updates, the actual content is administrative guidance for insurance agents and brokers, not billing code changes.
Low impact
R13770CP: Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides updated contact information and resources for insurance agents and brokers working with the Health Insurance Marketplace, including help desk phone numbers, email addresses, and useful websites. Despite the title referencing ESRD payment systems, the content is entirely focused on agent/broker support resources.
Low impact
R3P249i: This transmittal updates Chapter 49, Skilled Nursing Facility and Skilled Nursing Facility Healthcare Complex Cost Report, Form CMS-2540-24, revising the existing instructions, worksheets, and electronic cost report (ECR) specifications
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (Healthcare.gov). It lists help desk phone numbers, email addresses, hours of operation, and useful websites for agent registration, training, and consumer assistance.
Low impact
R7P247i: This transmittal updates Chapter 47, Home Health Agency Cost Report, Form CMS-1728-20, by clarifying the existing instructions, forms, and electronic cost report (ECR) specifications
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (Healthcare.gov). It includes help desk phone numbers, email addresses, hours of operation, and useful websites for agent registration, training, and consumer assistance.
Low impact
R7P246i: This transmittal updates Chapter 46, Rural Health Clinic (RHC) Cost Report, FormCMS-222-17, by clarifying the existing instructions, forms, and electronic cost report (ECR)specifications.
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes help desk contact details, hours of operation, and useful websites for marketplace registration and training processes.
Low impact
R9P244i: This transmittal updates Chapter 44, Federally Qualified Health Center (FQHC) Cost Report,Form CMS-224-14, by clarifying the existing instructions, forms, and electronic cost report(ECR) specifications.
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This transmittal provides updated contact information and help desk resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes phone numbers, email addresses, hours of operation, and useful websites for marketplace registration, training, and consumer assistance.
Low impact
R13799CP: Updates to Publication 100-04, Chapter 4, Section 250.3.3.1 and 250.18 of the Internet Only Manual (IOM) for Critical Access Hospital (CAH) Line Level Rendering Providers
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides updated contact information and resources for insurance agents and brokers working with the Health Insurance Marketplace (ACA Exchange plans). It includes help desk phone numbers, email addresses, and websites for agent registration, training, and consumer assistance.
Low impact
R13798OTN: Send 'Reason for Denial' Value in Prior Authorization Data to the Integrated Data Repository (IDR)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This appears to be a document listing CMS help desk contact information for agents and brokers working with the Federal Marketplace, not an actual policy change about prior authorization data or billing procedures. The title references sending 'Reason for Denial' values to an Integrated Data Repository, but the content is entirely help desk contact information.
Low impact
R13800CP: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document appears to be mislabeled - the title references a CMS transmittal about Transcatheter Tricuspid Valve Replacement (TTVR), but the content is actually a reference guide for insurance agents and brokers working with the Health Insurance Marketplace. The content provides contact information for various help desks and resources for marketplace registration and enrollment assistance.
Low impact
R13800NCD: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document appears to be misclassified - it contains agent/broker help desk contact information and marketplace resources, not a policy about Transcatheter Tricuspid Valve Replacement (TTVR). The content is entirely focused on CMS marketplace support resources for insurance agents and brokers.
Low impact
R13801CP: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document appears to be an agent/broker help desk contact guide for the Health Insurance Marketplace, not a policy about Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation as indicated in the title. The content provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace.
Low impact
R13801NCD: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document appears to be a mismatched policy - the title references a CMS NCD for Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation, but the content is actually a help desk reference guide for insurance agents and brokers working with the Health Insurance Marketplace. This is likely a filing error and does not contain any medical billing policy changes.
Low impact
R13802CP: NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document appears to be mislabeled - it contains agent/broker help desk information and marketplace resources rather than the stated NCD 20.40 Renal Denervation policy. The content provides contact information and websites for insurance agents working with the Health Insurance Marketplace, with no clinical or billing policy changes.
Low impact
R13802NCD: NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for insurance agents and brokers working with the Health Insurance Marketplace, not a policy change affecting medical billing. The title reference to Renal Denervation appears to be incorrect - the actual content is about marketplace agent/broker help desks and websites.
Low impact
R13803CP: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Updates for Shared System Edits for Category II Codes, Care Coordination Services and Revisions to the Internet Only Manual (IOM) Publications (Pub.) 100-04, Chapter 9
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (FFM). It contains help desk phone numbers, email addresses, and websites but does not announce any policy changes affecting medical billing or healthcare providers.
Low impact
R13806NCD: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy document appears to be mislabeled - despite the title referencing Cardiac Contractility Modulation (CCM) for Heart Failure, the content is actually an agent/broker help desk directory for the Federally-facilitated Marketplace. The document provides contact information and resources for insurance agents and brokers working with marketplace enrollment, not medical billing guidance.
Low impact
R13806CP: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for insurance agents and brokers working with the Health Insurance Marketplace, but does not contain any policy changes related to Cardiac Contractility Modulation (CCM) for Heart Failure as indicated in the title. The content appears to be a reference guide for marketplace help desks and websites.
Low impact
R13807CP: July 2026 Quarterly Update to the Clinical Laboratory Fee Schedule (CLFS) and ClinicalLaboratory Improvement Amendments (CLIA): Healthcare Common Procedure Coding System(HCPCS) Codes, Waived Tests, and Reasonable Charge Payments
Medicare/CMS - Transmittals·Identified Jun 16, 2026
There appears to be a mismatch between the policy title (Clinical Laboratory Fee Schedule and CLIA updates) and the actual content (Agent/Broker Marketplace Help Desk directory). The provided content only contains contact information and resources for insurance agents and brokers, not clinical laboratory billing changes.
Low impact
R13808NCD: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (Healthcare.gov). It contains help desk phone numbers, email addresses, and useful websites but does not contain any medical billing policy changes or clinical coverage decisions.
Low impact
R13808CP: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for agents and brokers working with the Health Insurance Marketplace, not a policy change affecting medical billing or reimbursement. It contains help desk contacts, websites, and operational guidance for insurance agents.
Low impact
R242SOMA: Revisions to the State Operations Manual (SOM) Chapter 9 Exhibits.
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides contact information and resources for insurance agents and brokers working with the Federally-facilitated Marketplace (Healthcare.gov). It includes help desk phone numbers, email addresses, hours of operation, and useful websites for marketplace registration and training.
Low impact
R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This appears to be a mislabeled document - the title references IOM updates and National Coverage Determinations for January 2026, but the content is actually an agent/broker help desk contact directory for the Federally-facilitated Marketplace from May 2024. No actual policy changes for medical billing are present in this document.
Low impact
R13816OTN: Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange(EDI) Front End Updates for October 2026
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and help desk resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It outlines various support channels for registration, training, enrollment assistance, and technical issues related to marketplace operations.
Low impact
R13818OTN: Implementation of Editing for Programs of All-Inclusive Care for the Elderly (PACE) Inpatient Claims Submitted for Indirect Medical Education (IME) Payment
Medicare/CMS - Transmittals·Identified Jun 16, 2026
There appears to be a mismatch between the policy title (PACE Inpatient Claims IME Payment editing) and the actual content (Agent/Broker Marketplace Help Desk contact information). The provided content is administrative guidance for insurance agents and brokers working with the Federally-facilitated Marketplace, not billing policy changes.
Low impact
R13821PI: Updates of Chapters 3, 4, and Exhibits in Publication (Pub.) 100-08, Including Updates to the Provider Notification Process and Vetting with the CMS Process
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides a comprehensive directory of CMS help desk contacts and resources for agents and brokers working with the Federally-facilitated Marketplace. It includes updated contact information, hours of operation, and available websites for marketplace registration, training, and consumer assistance.
Low impact
R13822CP: Quarterly Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and resources for agents and brokers working with the Health Insurance Marketplace (FFM). It contains help desk contact numbers, email addresses, and useful websites for marketplace registration, training, and consumer assistance.
Low impact
R13825FM: Updates to the Internet Only Manual, Publication 100-06, Chapter 3, Overpayments, Section 140-140.8.4 - Bankruptcy
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This document provides contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It contains help desk phone numbers, email addresses, hours of operation, and useful websites for marketplace registration and training. This is not a policy change affecting medical billing operations.
Low impact
R13826CP: Medicare Beneficiary Date of Death - Manual Update
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and help desk resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes phone numbers, email addresses, hours of operation, and website resources for various marketplace-related inquiries and support services.
Low impact
R243SOMA: Revisions to State Operations Manual (SOM), Chapter 5
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy update provides a comprehensive directory of CMS help desks and contact information for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes phone numbers, email addresses, hours of operation, and useful websites for various marketplace-related inquiries and technical support.
Low impact
R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical & Reimbursement (PS&R) System
Medicare/CMS - Transmittals·Identified Jun 16, 2026
This policy provides updated contact information and resources for agents and brokers working with the Federally-facilitated Marketplace (FFM). It includes help desk contact details, hours of operation, and useful websites for Marketplace registration and training.

All payers

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Medicare/CMS - Transmittals Policy Changes 2026 | Prior Auth & Coverage Updates | PolicyChanges.app

R13784CP: October 2026 Healthcare Common Procedure Coding System (HCPCS) Quarterly Update Reminder

R13770CP: Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)

R3P249i: This transmittal updates Chapter 49, Skilled Nursing Facility and Skilled Nursing Facility Healthcare Complex Cost Report, Form CMS-2540-24, revising the existing instructions, worksheets, and electronic cost report (ECR) specifications

R7P247i: This transmittal updates Chapter 47, Home Health Agency Cost Report, Form CMS-1728-20, by clarifying the existing instructions, forms, and electronic cost report (ECR) specifications

R7P246i: This transmittal updates Chapter 46, Rural Health Clinic (RHC) Cost Report, FormCMS-222-17, by clarifying the existing instructions, forms, and electronic cost report (ECR)specifications.

R9P244i: This transmittal updates Chapter 44, Federally Qualified Health Center (FQHC) Cost Report,Form CMS-224-14, by clarifying the existing instructions, forms, and electronic cost report(ECR) specifications.

R13799CP: Updates to Publication 100-04, Chapter 4, Section 250.3.3.1 and 250.18 of the Internet Only Manual (IOM) for Critical Access Hospital (CAH) Line Level Rendering Providers

R13798OTN: Send 'Reason for Denial' Value in Prior Authorization Data to the Integrated Data Repository (IDR)

R13800CP: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)

R13800NCD: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)

R13801CP: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

R13801NCD: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

R13802CP: NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension

R13802NCD: NCD 20.40- Renal Denervation (RDN) for Uncontrolled Hypertension

R13803CP: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Updates for Shared System Edits for Category II Codes, Care Coordination Services and Revisions to the Internet Only Manual (IOM) Publications (Pub.) 100-04, Chapter 9

R13806NCD: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

R13806CP: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

R13807CP: July 2026 Quarterly Update to the Clinical Laboratory Fee Schedule (CLFS) and ClinicalLaboratory Improvement Amendments (CLIA): Healthcare Common Procedure Coding System(HCPCS) Codes, Waived Tests, and Reasonable Charge Payments

R13808NCD: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)

R13808CP: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)

R242SOMA: Revisions to the State Operations Manual (SOM) Chapter 9 Exhibits.

R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197

R13816OTN: Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange(EDI) Front End Updates for October 2026

R13818OTN: Implementation of Editing for Programs of All-Inclusive Care for the Elderly (PACE) Inpatient Claims Submitted for Indirect Medical Education (IME) Payment

R13821PI: Updates of Chapters 3, 4, and Exhibits in Publication (Pub.) 100-08, Including Updates to the Provider Notification Process and Vetting with the CMS Process

R13822CP: Quarterly Update to the End Stage Renal Disease Prospective Payment System (ESRDPPS)

R13825FM: Updates to the Internet Only Manual, Publication 100-06, Chapter 3, Overpayments, Section 140-140.8.4 - Bankruptcy

R13826CP: Medicare Beneficiary Date of Death - Manual Update

R243SOMA: Revisions to State Operations Manual (SOM), Chapter 5

R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical &amp; Reimbursement (PS&amp;R) System

R13785FM: The Fiscal Intermediary Shared System (FISS) Submission of Copybook Files to the Provider Statistical & Reimbursement (PS&R) System