Retirement of Select Medicare Payment Policies - Effective November 22, 2026

Policy Update #: POLMEDPAY11222026
Effective Date: 11/22/2026
Current State: We are notifying providers that several Medicare payment policies are being formally retired. These policies are being retired to align with CMS standards and eliminate duplicative or potentially conflicting guidance. Providers should follow Centers for Medicare & Medicaid Services (CMS) guidance for appropriate billing and coding requirements for the Medicare line of business, including the Dual Special Needs Plan, (also known as D-SNP).
Future State: Providers are expected to follow current CMS rules when submitting Medicare/D-SNP claims, including but not limited to.

• Medicare Claims Processing Manual
• Medicare Benefit Policy Manual
• National Correct Coding Initiative (NCCI) edits
• CMS transmittals and Medicare Learning Network (MLN) publications

Applicable Plan(s): Medicare
Applicable Policy: See below.
Business Owner: Cost of Care

The following payment policies will no longer include Medicare line of business:

• General Billing and Coding (#3812)
• General Clinical Editing (#3814)
• Co-Surgeon Payment Policy (#3905)
• After-Hours and Weekend Care Payment Policy (#3946)
• Diagnosis-Related Group Acute Facility Transfers (#3960)
• Standby Services Payment Policy (#3964)
• Post-Acute Transfer (#3968)
• Status T Codes, Professional (#3977)
• B Bundle Codes, Professional (#3979)
• Discarded Drugs and Biological Policy, Professional (#4008)
• Clinical Diagnostic Lab Policy, Professional (#4024)
• Medical Unlikely Edits Policy, Prof. and Facility (#4033)
• Place of Service Payment Policy (#4254)
• Hospital Acquired Condition/Never Event (#4382)
• Hearing Services (#4402)
• Orthotics and Prosthetic Payment Policy (#4415)
• Allergy Testing and Treatment Payment Policy (#4394)
• Ambulance-Medicare (#3818)
• CLIA Waiver Payment Policy (#4052)
• Collaborative Care Management and Behavioral Health Integration-Medicare (#4425)
• Contrast and Radiopharmaceutical Materials Policy (#4019)
• Durable Medical Equipment Payment Policy Medicare (#4003)
• Multiple Procedure Payment Reduction for Diagnostic Cardiovascular and Ophthalmology Professional (#4016)
• NCCI Edits Payment Policy Medicare (#3966)
• Preventative Medicine and Screening Policy-Medicare (#4369)
• Psychological and Neuropsychological Testing Payment Policy Medicare (#4038)
• Telehealth (#3825)

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Retirement of Select Medicare Payment Policies - Effective November 22, 2026