2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
AI 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.
Action Required
By March 1, 2026: Switch to electronic CLIA fee coupons and certificates - email your state agency or contact accreditation organization. By March 31, 2026: Eligible hospitals must submit OPPS drug acquisition cost survey data. By May 7, 2026: Update MAC portal users to associate with NPIs to maintain MBI lookup tool access. Immediately: Begin using new hypoglossal nerve neurostimulator codes C8007-C8013 effective January 1, 2026. Use updated CY 2026 KX modifier threshold of $2,480 for therapy services.
Affected Billing Codes
Plan Types
Traditional Medicare, Medicaid
Specialties
all-specialties, laboratory, physical-therapy, occupational-therapy