Traditional MedicareAdministrativeMedium impact
2025-12-11 - CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity
Medicare/CMS·Payment
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
CMS has finalized new DMEPOS accreditation provisions to enhance program integrity, with multiple payment rate updates and billing changes effective January 1, 2026. Key changes include new institutional provider enrollment fees of $750, updated payment rates for various services, and new billing requirements for critical access hospitals.
Action Required
By January 1, 2026: Billing teams must update payment rates for Q2052 to $442.19, implement new $750 enrollment application fee for institutional providers adding practice locations or revalidating enrollment, and ensure critical access hospitals have proper physician reassignment forms filed in PECOS before January 2, 2026 to avoid claim returns. Update billing systems with new CPT code 91323 and remove code 91318 for COVID-19 vaccine administration. Register for OPPS Drug Acquisition Cost Survey if hospital received outpatient drug payments from July 2024-June 2025.