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Medicare/CMSTraditional Medicare · Administrative · Payment · Physical Therapy, Occupational TherapyHigh impact

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

Act
by Mar 1, 2026
Effective date
Jan 1, 2026
Identified
Feb 27, 2026

Summary

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.

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What to do

by Mar 1, 2026 · 5 steps
01Switch to electronic CLIA fee coupons and certificates - email your state agency or contact accreditation organization.
02By March 31, 2026: Eligible hospitals must submit OPPS drug acquisition cost survey data.
03By May 7, 2026: Update MAC portal users to associate with NPIs to maintain MBI lookup tool access.
04Immediately: Begin using new hypoglossal nerve neurostimulator codes C8007-C8013 effective January 1, 2026.
05Use updated CY 2026 KX modifier threshold of $2,480 for therapy services.

Codes mentioned

C8007C8008C8009C8011C8012C8013G0567Q2052G9871

Original notice

2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
cms.gov · Always check the source before changing claims.
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Related changes

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2026-07-16 - CY 2027 Medicare Physician Fee Schedule Proposed RuleHighEffective Jan 1, 2027 · Payment2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule ResourcesMediumNo effective date · Prior Authorization2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31MediumEffective Jan 1, 2026 · Payment2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program IntegrityMediumEffective Jan 1, 2026 · PaymentBrowse every Medicare/CMS change in the policy list

Related policy hubs

Medicare/CMS policiesPhysical TherapyOccupational TherapyCode C8007Code C8008Code C8009Code C8011Code C8012Code C8013Code G0567Code Q2052Code G9871

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