Traditional MedicareAdministrativeHigh impact
2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
Medicare/CMS·Physical Therapy, Occupational Therapy·Payment
Effective date
Jan 1, 2026
We identified it
Feb 27, 2026
Summary
CMS announced a major healthcare fraud crackdown including a nationwide moratorium on Medicare enrollment for certain DMEPOS suppliers and enhanced monitoring of MAC MBI lookup tools. Additionally, multiple billing updates are effective including new hypoglossal nerve neurostimulator codes, mandatory electronic CLIA certificates after March 1, and updated therapy service thresholds.
Action Required
By March 1, 2026: Switch to electronic CLIA fee coupons and certificates - email your state agency or contact accreditation organization. By March 31, 2026: Eligible hospitals must submit OPPS drug acquisition cost survey data. By May 7, 2026: Update MAC portal users to associate with NPIs to maintain MBI lookup tool access. Immediately: Begin using new hypoglossal nerve neurostimulator codes C8007-C8013 effective January 1, 2026. Use updated CY 2026 KX modifier threshold of $2,480 for therapy services.