Traditional MedicareBilling CodesMedium impact
2026-09-03 - Arkansas: $149.3M to Expand Telehealth & Increase Access to Specialty Care and Preventive Screenings
Medicare/CMS·Gastroenterology, Oncology, General Surgery +2 more·General
Effective date
Oct 1, 2026
We identified it
Sep 3, 2026
Summary
This MLN Connects newsletter (Sept 3, 2026) contains multiple Medicare policy updates affecting billing and compliance. Key changes include: (1) CPT code 0421U for colorectal cancer screening will be available in HETS eligibility starting January 2027; (2) DMEPOS benefit category determinations updated in the Medicare Benefit Policy Manual; (3) October 2026 updates to Medicare Physician Fee Schedule Database and National Correct Coding Initiative (NCCI) effective October 1, 2026; (4) New National Coverage Determination 210.3 for non-invasive biomarker colorectal cancer screening tests effective June 8, 2026; and (5) Consolidated billing enforcement updates for skilled nursing facilities.
Action Required
REQUIREMENTS: By October 1, 2026: Billing team must update systems to implement National Correct Coding Initiative (NCCI) first quarter edit files (effective October 1, 2026), including procedure-to-procedure edits, medically unlikely edits, and add-on code edits. Update Medicare Physician Fee Schedule Database with October quarterly updates (new codes, procedure status changes, short descriptor revisions, payment policy indicator changes). By January 1, 2027: Verify that billing software can process CPT code 0421U (non-invasive biomarker colorectal cancer screening test - ColoSense) and confirm HETS eligibility history returns properly. Review DMEPOS benefit category determinations in Medicare Benefit Policy Manual Chapter 15, Section 110.8 and update benefit category coding in billing system. Verify compliance billing for oral anticancer and antiemetic drugs to prevent 37.7% improper payment rate. Audit all skilled nursing facility consolidated billing codes per October 2026 quarterly update. Failure to implement NCCI edits and fee schedule updates will result in claim rejections and denials.