Retirement of Select Medicare Payment Policies

Policy Update #: POLMEDPAY08102026
Effective Date: 08/10/2026, 8/27/2026 & 09/8/2026
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:

• Always Therapy Modifiers Payment Policy (#4061) Effective 8/10/2026
• Dialysis (#4404) Effective 8/10/2026
• Drug Testing Payment Policy (#4064) Effective 8/10/2026
• KX Modifier Payment Policy (#4060) Effective 8/10/2026
• Laboratory Services Payment Policy (#4389) Effective 9/8/2026
• Modifier FS Split Shared Visit (#4075) Effective 8/10/2026
• Modifier 25 Payment Policy (#4367) Effective 8/10/2026
• Modifier 57 Payment Policy (#4370) Effective 8/10/2026
• Repeat Admission (#3999) Effective 8/10/2026
• Robotic Assisted Surgery Payment Policy (#3827) Effective 8/27/2026

Important Reminders:

• Ensure coding reflects services rendered and documentation supports medical necessity.
• Follow CMS guidance for modifiers, bundling rules, and service limitations.
• Maintain awareness of ongoing CMS updates, as this guidance may evolve.

Questions and Support: If you have questions regarding this change or need assistance interpreting CMS guidance, please contact your Provider Services representative or refer to CMS resources directly at www.cms.gov.

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Retirement of Select Medicare Payment Policies