The 974 Days Behind Medicare's Newest Claims Edit
CMS issued three change requests in the week of November 2. One takes effect April 1, 2027, one takes effect June 30, 2026, and the edit inside the third is dated March 6, 2024. Meanwhile the local half of the Medicare Coverage Database posted nothing at all, the first empty week in the twenty-three we measured.
Three change requests came off the CMS transmittal page in the week of November 2. Not one of them takes effect in the week of November 2.
CR 14653 is effective April 1, 2027, and so is CR 14670.
CR 14645, issued Thursday, is effective June 30, 2026, and the first edit inside it is dated March 6, 2024.
That last one is the interesting document, and we have been waiting for it since September.
"If the coverage started in June and the edit installs in April, who is adjudicating the claims in between?"
The April 2027 CR, Right On Schedule
Back on September 25 we read Transmittal 13968, which rescinded and replaced Transmittal 13910 for one stated reason:
"to remove NCD 110.23 Stem Cell, by removing business requirements 14464.4 through 14464.4.1.1, as it will be added to an April 2027 CR."
We logged that at the time and declined to assert the April 2027 CR would actually show up. It showed up Thursday.
R14035CP, change request 14645, Pub. 100-04, subject "Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) National Coverage Determination (NCD) 110.23 Coding Updates." Implementation date April 5, 2027. Impacted contractors: A/B MAC Part A.
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