Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) is the federal agency within the U.S. Department of Health and Human Services responsible for administering Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. Founded in 1977, CMS serves as the regulatory and oversight body for these national health programs, affecting coverage for over 100 million Americans.

CMS establishes fee schedules, coverage policies, coding standards, and billing regulations that healthcare providers, payers, and technology vendors must follow. The agency maintains resources including physician fee schedule lookup tools, the Medicare Coverage Database, ICD-10 coding standards, and coverage determinations. CMS also operates the Innovation Center to test new payment and service delivery models.

Current priorities include the Rural Health Transformation Program, modernizing the nation's health technology ecosystem, combating fraud and abuse, implementing Medicare drug price negotiation, and supporting healthcare agents and brokers through marketplace programs.

Healthcare organizations interact with CMS when they need to comply with Medicare and Medicaid regulations, understand payment policies, obtain necessary billing codes, or participate in federal health programs. CMS resources are essential for providers seeking reimbursement, technology vendors building compliant solutions, and organizations serving federally-insured populations.

The agency provides authoritative guidance on coverage policies, coding standards, and billing requirements that form the foundation of healthcare operations in the United States. Organizations can access lookup tools, databases, manuals, and training materials to ensure compliance and successful program participation.

CMS operates exclusively within healthcare as the federal administrator of Medicare, Medicaid, CHIP, and the Health Insurance Marketplace. The agency serves hospitals, health systems, payers, physicians, and other providers across all healthcare verticals. CMS establishes HIPAA compliance standards, maintains coding systems used throughout the industry, and sets coverage and payment policies that influence healthcare delivery nationwide.

Specialized resources address specific healthcare needs including clinical laboratory billing, durable medical equipment, ambulatory surgical centers, and telehealth services. Recent initiatives target rural healthcare access, prescription drug affordability, and health technology infrastructure modernization.

Healthcare providers billing Medicare or Medicaid, health insurance companies participating in federal marketplaces, healthcare technology vendors building compliant solutions, state Medicaid agencies, insurance agents and brokers selling marketplace plans, and organizations serving Medicare or Medicaid beneficiaries who need access to authoritative regulatory guidance and coding resources.