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Deductible and Coinsurance
View premium, deductible, and coinsurance costs for people with Medicare.
CMS Accessible Communications
For information about the availability of auxiliary aids and services, please visit:
https://www.medicare.gov/about-us/accessibility-nondiscrimination-notice
Regulation
- Centers for Medicare & Medicaid Services (CMS) Website
Find CMS resources such as manuals, an acronym lookup, Medicare Learning Network publications, HIPAA information, the Medicare Physician Fee Schedule, and Frequently Asked Questions. - CMS Manuals
The Internet-Only Manuals (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. The Paper-Based Manuals include the Provider Reimbursement Manual - Part 1 (Pub 15-1), the Provider Reimbursement Manual - Part 2 (Pub 15-2), and the State Medicaid Manual (Pub 45). - 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.
Coverage and Guidance
- CMS Medicare Coverage Database (MCD) Reports
Find current and proposed Local Coverage Determinations by Contractor - Cognitive Assessment & Care Plan Services
Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan. - Prevention - General Information
- View information about preventive services and screenings covered by Medicare.
- Provider Compliance Tips for Polysomnography (Sleep Studies)
Learn about common reasons for claim denials, coverage criteria, and ways to prevent denials. - Practitioner & DMEPOS Supplier Information on Power Mobility Devices
Learn coverage criteria, programs that may affect reimbursement, and provider and supplier requirements.
Billing Resources
- Information for Critical Access Hospitals (CAH) booklet
This booklet explains how to properly document and bill for services including: bed and board, nursing and other related services, facilities, medical social services, drugs, biologicals, supplies, appliances, and equipment for impatient hospital care and treatment. - Flu Shots
Find billing, coding, and payment information for flu shot providers. - Hospital Outpatient PPS - Addendum A and Addendum B Updates
Access quarterly Addendum A and Addendum B updates. - ICD-10
Access information about the transition to ICD-10. - Medicare Payment Systems Educational Tool
Learn how billing and payment works for hospitals, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, ambulatory surgical centers, and skilled nursing facilities payment systems. - Medicare Documentation Job Aid for Doctors of Chiropractic
Learn about responding to medical records requests, documentation to support medical necessity, and medical records that 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. - Transplant
Find basic information about organ transplant programs - 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 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.
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® (MLN) 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 websites by visiting the Physician Center webpage 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 https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.
Sign up for the Centers for Medicare & Medicaid Services' Medicare Learning Network Listserv!
Be among the first to know about new and updated MLN products and resources by subscribing to the MLN Education Products listserv. To sign up, go to http://list.nih.gov. In the ‘Browse’ section, select ‘Search Public Lists.’ 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 your joining the Medicare Learning Network® family.
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You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
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