CMS Final Rule Updates and DME MAC Resources

The DME MACs jointly published a billing and coding article with guidance pertinent to lymphedema compression treatment items, including proper use of four modifiers that will go into effect for claims with dates of service on or after Jan. 1, 2026. You can find out which modifiers are required for a specific HCPCS code via the Modifier tools found on both the CGS and Noridian websites (make sure you’re viewing your correct jurisdiction for the tool). Read the full articles from Noridian and CGS.

Final Rule CMS-1828-F includes updates to the Competitive Bidding Program (CBP) and other provisions related to provider enrollment and prior authorization. CMS expects to implement the next round of the CBP by Jan. 1, 2028 (view the proposed timeline). Also, CMS has expanded its authority to monitor, audit, suspend or revoke accreditation status of poorly performing Accredited Organizations (AO) or non-compliant suppliers. For DMEPOS suppliers, the accreditation cycle will shift from every three years to annually. Review the CMS fact sheet or contact your specific AO with questions.