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, an acronym finder, MLN Matters articles, HIPAA information, the Medicare Physician Fee Schedule, and Frequently Asked Questions.
- CMS Internet-Only Manual (IOM) System
Access to the entire CMS online manual system. The IOMs are CMS' program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, 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
Access program transmittals used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed.
- CMS.HHA.gov Email Updates List
Sign up to receive emails about the latest CMS Fee-for-Service (FFS) initiatives. Simply provide a valid email address, and you can start receiving electronic updates automatically.
- Federal Digital System
Access official publications from all three branches of the Federal Government.
- MLN Matters Articles
View a series of national articles designed to inform the physician, provider, and supplier community about the latest changes to the Medicare Program (commonly referred to as Change Requests (CRs)). Articles are prepared in consultation with clinicians, billing experts, and CMS subject matter experts which are tailored in content and language to the specific provider type(s) affected by a particular Medicare change. Articles are developed to accompany recently released Medicare program instruction.
- Quarterly Provider Updates
Access the Quarterly Provider Update, a comprehensive resource published by CMS on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare, including Program Memoranda, manual changes, and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the Update. You can also sign up for the CMS Quarterly Provider Updates Email Updates to receive notification via email when regulations and program instructions are added throughout the quarter.
- Regulations & Guidance
View Medicare regulations and guidance, including information on health insurance reform, HIPAA, and legislation.
Coverage and Guidance
- CMS Local Coverage Determinations (LCDs) by Contractor Index
View Local Coverage Determinations (LCDs), policies created by a Medicare Administrative Contractor (MAC). All LCDs, both current and those under development are available on this Index.
- How to Access Updates to ICD-10 Local Coverage Determinations in the CMS Medicare Coverage Database (SE 1421)
Learn how to access updates to International Classification of Diseases, 10th Edition (ICD-10) LCDs in the CMS Medicare Coverage Database (MCD).
- How to Access Updates to ICD-10 Local Coverage Determinations in the CMS Medicare Coverage Database (SE 1421)
- CMS Medicare Coverage Center
Access several national databases to search and view current policies, retired policies, and coverage articles for any Medicare contractor. In addition, you can access the minutes from the Medicare Coverage Advisory Committee (MCAC) meetings and learn how the Medicare Modernization Act (MMA) affected Medicare policy.
- Evaluation and Management (E/M) Services Guide
View information regarding medical record documentation, ICD-9-CM diagnosis codes, CPT codes, and key elements of service in relation to E/M Services.
- Medicare Prescription Drug Coverage
View information about Medicare Part D, Prescription Drug Coverage.
- 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
- Competitive Acquisition for Part B Drugs & Biologicals - Information for Physicians
Scroll to the bottom of the page to download the Beneficiary Fact Sheet for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals. Physicians who elect to participate in the CAP are required to provide the CAP Beneficiary Fact Sheet to Medicare beneficiaries who are receiving certain Part B physician-administered drugs.
- CMS Forms List
Download a wide variety of CMS forms, as well as filing instructions.
- DMEPOS Competitive Bidding
- Access information on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding. This information is aimed at the Non-Contract Supplier and Referral Agent Community.
- 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 Remit Easy Print (MREP)
Download software to view and print the HIPAA-compliant 835 for providers and suppliers. This software, available free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835.
- Medicare Physician Fee Schedule
View information on services included in the Medicare Physician Fee Schedule (MPFS). Access information about more than 10,000 physician services, the associated relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). View or print the Key to the MPFSDB Indicators (file name: RVU18A.pdf). The full National Physician Fee Schedule Payment Amount File is available by following this link.
- 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 edits are applied to services billed by the same provider for the same beneficiary on the same date of service. All claims are processed against the CCI tables.
- Physician Quality Reporting System (PQRS)
Sign up for the Physician Quality Reporting System (Physician Quality Reporting or PQRS) or learn more about PQRS reporting.
- Remittance Advice Reason and Remark Codes
View descriptions for Remittance Advice reason and remark codes.
- Remittance Advice Information: An Overview
Download a fact sheet that includes general information about the RA, the benefits of using the electronic RA, what kind of information is in an RA, and what to do once you get one.
Download a list of facilities that are certified for Medicare payment of transplants for non-renal organs, 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).
NPI (National Provider Identifier)
- National Plan and Provider Enumeration System (NPPES)
Apply for your National Provider Identifier through Fox Systems. This website also provides further information about the NPI. The NPI replaced previous versions of health care provider identifiers (e.g. UPIN) used in standard health care transactions.
Providers/Suppliers - General Information
Find definitions for acronyms found on the CMS website and other common acronyms.
- 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 Outreach and Education
Access information about CMS training, CMS outreach, and the Medicare Learning Network (MLN).
- 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.
- Medicare Provider/Supplier Enrollment
Access provider/supplier enrollment forms, specific requirements for provider/supplier types, manual instructions, troubleshooting, contact information, hot topics, and other pertinent information.
- MLN Connects Provider eNews Archive
View an archive of MLN Connects Provider eNews weekly publication from December 2011 to the present.
- Partner with CMS
Partner with CMS on a variety of programs.
- Physician Center
Access information about participation in the Medicare program, an Advance Beneficiary Quick Reference Guide, HIPAA information, and many other useful tools for the provider community.
- Physician Compare
Physician Compare serves a two-fold purpose; to provide information to help consumers make informed decisions about their health care and to create clear incentives for physicians to perform well. Additional information is available on the CMS Physician Compare Initiative web page.
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)
- HIPAA - General Information
Access the latest HIPAA news, educational materials, Frequently Asked Questions, a glossary of terms, links to various other websites and many other HIPAA-related resources on the CMS site.
- Understanding Health Information Privacy
View HIPAA fact sheets, instructions on how to file a health information privacy complaint, educational materials, Frequently Asked Questions, information on The Privacy Rule and many other HIPAA-related resources on the Office for Civil Rights 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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