Several recent CMS and Medicare updates may impact laboratory operations, billing compliance, and coverage requirements. Below is a high-level overview of what’s changing and where providers should pay close attention.
CLIA Program: Paper Fee Coupons & Certificates Ending March 1
Centers for Medicare & Medicaid Services is transitioning the CLIA program to fully electronic communications. After March 1, 2026, paper CLIA fee coupons and certificates will no longer be mailed, and payments must be made online — checks will no longer be accepted. Laboratories must enroll in CMS email notifications to avoid certification or billing disruptions. (CLIA-exempt states are not affected.)
Optometry Services at Nursing Facilities: Billing Accuracy Required
A recent audit by the Office of Inspector General found that Medicare improperly paid for high-level E/M services billed by optometrists in nursing facilities. These services typically do not meet Medicare’s complexity requirements when performed by optometrists. CMS reminds providers to follow proper billing guidance for covered vision services and avoid E/M codes that do not meet criteria.
Home-Based Ventilation for COPD: Coverage Revisions
CMS has revised coverage for home-based noninvasive positive pressure ventilation used to treat chronic respiratory failure due to COPD. HCPCS code E0465 and specific ICD-10 diagnosis codes were removed, with Medicare Administrative Contractors now managing ICD-10 determinations at the local level.
Renal Denervation for Hypertension: NCD Update
CMS updated National Coverage Determination (NCD) 20.40 for renal denervation in patients with uncontrolled hypertension. Changes include new outpatient claims processing instructions, expanded allowable place-of-service codes, and clarification that CPT code 0935T may only be used for professional claims.