Deductible and Coinsurance
View premium, deductible, and coinsurance costs for people with Medicare.
For information about the availability of auxiliary aids and services, please visit:
- Centers for Medicare & Medicaid Services (CMS) Website
Find CMS resources such as manuals, and acronym lookup, Medicare Learning Network publications (e.g. MLN Matters articles), HIPAA information, the Medicare Physician Fee Schedule, and Frequently Asked Questions.
- CMS Internet-Only Manual (IOM) System
The IOMs include CMS program issuances, day-to-day operating instructions, policies, and procedures. Providers, contractors, Medicare Advantage organizations, and state survey agencies use the IOMs to administer CMS programs.
- CMS Medicare Administrative Contractors (MACs)
Access information about Medicare Administrative Contracts.
- CMS Transmittals
Find program transmittals used to communicate new or changed policies, and/or procedures that CMS will incorporate into a program manual.
- Federal Register
Find Federal agency regulations, Proposed Rules and Notices of interest to the public, Executive orders, Proclamations, and other Presidential documents.
- Quarterly Provider Updates
The Quarterly Provider Update is a comprehensive resource for all non-regulatory changes to Medicare. CMS publishes the Quarterly Provider Update on the first business day of each quarter. You can also sign up for the CMS quarterly Provider Updates Email Updates to receive notification via email when CMS adds regulations and program instructions throughout the quarter.
Coverage and Guidance
- CMS Local Coverage Determinations (LCDs) by Contractor Index
Find current and under development Local Coverage Determinations.
- Prevention - General Information
View information about preventive services and screenings covered by Medicare.
- Preventive Services Educational Tool
Coverage, coding, and billing information for preventive services
- Hospital Outpatient PPS - Addendum A and Addendum B Updates
Access quarterly updates to the OPPS website.
- ICD-9-CM and ICD-10 Diagnosis Codes
Access the new, revised, and deleted diagnosis codes, as well as other diagnosis code resources.
Access information about the transition to ICD-10.
- Medicare Documentation Job Aid for Doctors of Chiropractic
Learn about how to respond to medical records requests, documentation to support medical necessity and medical records which support “corrective treatment.”
- Medicare Remit Easy Print (MREP)
Providers and suppliers can download this free software to access and print remittance advice information, including special reports, from the HIPAA 835.
- National Correct Coding Initiative (NCCI)
Access information about the Correct Coding Initiative (CCI), edits that are pairs of Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Level II codes not separately payable except under certain circumstances. The system applies edits to services billed by the same provider for the same beneficiary on the same date of service. The system processes all claims against the CCI tables.
- Remittance Advice Reason and Remark Codes
View descriptions for Remittance Advice reason and remark codes.
Download a list of Medicare-certified facilities, along with the effective date of such certification. It includes a list of the Medicare Approved Transplant Centers for Heart, Lung and Heart-Lung, Liver, and Intestinal.
- ZIP Code Changes and ZIP Codes Requiring +4 Ext Files
Download ZIP code files used in the Prospective Payment System (PPS).
Providers/Suppliers - General Information
- All Fee-For-Service Providers Information
Access information for Fee-for-Service providers and suppliers.
- The American Health Quality Association (AHQA)
Access information about Quality Improvement Organizations (QIOs) on the AHQA website.
- CMS Forms List
Download CMS forms, as well as filing instructions.
- Medicare Administrative Contractor Satisfaction Indicator (MSI)
View information about the yearly MAC Satisfaction Indicator (MSI), a survey used by CMS to measure provider satisfaction with the MACs from which they receive services.
- Medicare Advantage (MA)/ Part D Contract and Enrollment Data
Access information on contracts and plans, enrollment numbers, service area data, and contact information for MA, Prescription Drug Plan (PDP), cost, PACE, and demonstration organizations.
Coordination of Benefits (COB) and Medicare Secondary Payer (MSP)
- CMS' Coordination of Benefits website
Access information about coordination of the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first.
- COBA Medigap Claim-Based IDs on CMS' Coordination of Benefits Website
Download a list of Medigap Claim-based COBA IDs To Be Used on Incoming Claims.
- COBC Trading Partner Customer Service Point-of-Contact List
Download a list of contacts for automatic Crossover Trading Partner (Insurers).
- Coordination of Benefits and You
Download COB fact sheets helpful in explaining provider/billing clerk responsibilities. These fact sheets cover issues such as MSP requirements, how to determine the primary payer, and guidelines for collecting, submitting, and updating beneficiary insurance information.
HIPAA (Health Insurance Portability & Accountability Act)
- Administrative Simplification Overview
Access the latest HIPAA news, educational materials, Frequently Asked Questions, and many other HIPAA-related resources on the CMS website.
Medicare Learning Network (MLN)
We encourage you to visit the Medicare Learning Network the place for official CMS Medicare fee-for-service provider educational information. There you can find one of our most popular products, MLN Matters national provider education articles. These articles help you understand new or changed Medicare policy and how those changes affect you. A full array of other educational products (including Web-based training courses, hard copy and downloadable publications, and CD-ROMs) are also available and can be accessed at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.html. You can also find other important Web sites by visiting the Physician Center Web page at: http://www.cms.gov/Center/Provider-Type/Physician-Center.html, and the All Fee-For-Service Providers Web page at: https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html.
In addition to educational products, the MLN also offers providers and suppliers opportunities to learn more about the Medicare program through MLN National Provider Calls. These national conference calls, held by CMS for the Medicare Fee-For-Service provider and supplier community, educate and inform participants about new policies and/or changes to the Medicare program. Offered free of charge, continuing education credits may be awarded for participation in certain National Provider Calls. To learn more about MLN National Provider Calls including upcoming calls, registration information, and links to previous call materials, visit http://www.cms.gov/Outreach-and-Education/Outreach/NPC/index.html.
Sign up for the Centers for Medicare & Medicaid Services' Medicare Learning Network Listserv!
Want to be among the first to know about new and updated Medicare Learning Network® (MLN) products and resources? The MLN Education Products listserv is for you! By joining this listserv you will receive the latest news about new and revised MLN products including information on Medicare-related topics such as provider enrollment, preventive services, claims processing, provider compliance, payment policies, and the MLN Provider Exhibit Program. MLN products are created in a variety of formats, such as fact sheets, brochures, quick reference charts, podcasts, and web-based training courses, to meet your preferred learning style.
To sign up go to http://list.nih.gov. In the search field, enter 'MLN' and select 'search'. Select MLN_EDUCATION_PRODUCTS-L. Follow the prompts to obtain a password. Once you create a password, you will be able to subscribe to a list and change your subscription options.
We look forward to you joining the Medicare Learning Network® family.
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