To increase oversight and transparency with respect to Medicare billing codes.
Sponsors
Legislative Progress
IntroducedMr. Ciscomani (for himself, Mr. Smucker, and Mrs. Harshbarger) introduced …
Summary
What This Bill Does
This bill requires increased oversight and public transparency of how Medicare adds new medical billing codes. The Department of Health and Human Services Inspector General must study how the Centers for Medicare & Medicaid Services (CMS) manages billing codes, and CMS must publish annual reports showing which new codes were added and how much they cost taxpayers.
Who Benefits and How
Congressional oversight committees gain better information to monitor Medicare spending patterns and identify potential areas of excessive cost growth or favoritism toward certain medical specialties. Healthcare policy researchers and transparency advocates benefit from access to detailed public data about billing code additions, volumes, and expenditures that was previously not systematically reported. Medicare fraud detection firms and consultants may gain new business opportunities as increased transparency makes it easier to identify anomalies in billing patterns.
Who Bears the Burden and How
The HHS Office of Inspector General must allocate staff time and resources to conduct a comprehensive study of CMS billing code processes and deliver recommendations to Congress within 12 months. CMS faces ongoing annual reporting requirements, needing to compile, verify, and publish data on every new billing code added each year, including associated volumes and expenditures. Medical specialties that have seen high growth in new billing codes may face increased scrutiny if the study highlights their patterns as outliers.
Key Provisions
- Mandates Inspector General study of CMS processes for adding, modifying, and removing Medicare billing codes, including analysis of data quality, specialty growth trends, and cost monitoring
- Requires Inspector General to submit findings and recommendations to Congress within 12 months of enactment
- Establishes annual reporting requirement starting June 1, 2025, where CMS must publicly list all new billing codes added in the prior year with their volumes and Medicare expenditures
- Creates permanent transparency mechanism allowing public and Congressional tracking of how Medicare billing complexity and costs evolve over time
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Increase oversight and transparency of Medicare billing code processes through Inspector General study and annual reporting requirements
Policy Domains
Legislative Strategy
"Establish accountability and transparency mechanisms for Medicare billing code management to address potential cost growth and specialty favoritism"
Likely Beneficiaries
- Congressional oversight committees
- Healthcare policy researchers
- Taxpayer advocacy groups
- Patient advocacy organizations
Likely Burden Bearers
- HHS Inspector General office (study workload)
- Centers for Medicare & Medicaid Services (annual reporting burden)
- Potentially: Medical specialties benefiting from less transparent code additions
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "cms"
- → Centers for Medicare & Medicaid Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_inspector_general"
- → Inspector General of the Department of Health and Human Services
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology