Regulatory
"What are the rules?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Federal Register -- rules and notices, 2010 on | CMS / NARA | Where rules are made and changed; annual payment rules live here | Carried |
| Code of Federal Regulations, Title 42 -- current text, 80 Medicare and Medicaid parts | CMS / NARA | What the regulation says today | Carried |
| CMS manuals -- fourteen publications: Claims Processing (all 39 chapters), Benefit Policy, Program Integrity, Secondary Payer, Managed Care, State Operations, and eight others | CMS | The operational rulebook billers work from | Carried |
| Transmittals / Change Requests | CMS | The diffs -- what changed in the manuals and when | Carried |
| MLN articles + booklets | CMS | Plain-language education that translates the rules | Carried |
Regulations and manuals are the current text as we captured it in 2026. Earlier versions of a rule are not covered. Federal Register documents published before 2010 are not included.
Coding & billing
"How do I describe the encounter?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| NCCI -- PTP edits (3.13M pairs) + MUEs (33,354 limits) + Policy Manual | CMS | Which codes can or cannot combine; per-line unit limits, and the rationale | Carried |
| HCPCS Level II -- 16,733 codes + descriptors | CMS | Supplies, drugs, and DME beyond CPT | Carried |
| ICD-10-CM Official Coding Guidelines + ICD-10-PCS | CDC/NCHS + CMS | Why the patient was seen; inpatient procedures | Carried |
| Place of Service (POS) -- 52 codes + descriptors | CMS | Where the service happened | Carried |
| Institutional code facts -- bill type, revenue, condition, value, occurrence (3,301 Medicare facts) | CMS (Pub 100-04) | How an institutional claim is structured, from CMS's own instructions | Carried |
| CPT code descriptions (Level I) | AMA | Physician / outpatient procedures. Codes are cited by number only | Cited only |
| Official UB-04 code tables (NUBC) | NUBC | The licensed institutional code lists. We carry what CMS itself says about those codes | Cited only |
| Coding advice publications | AHA and others | Interpretive coding advice | Not covered |
Individual code facts are not copyrightable; the curated tables and the proprietary descriptor text are. Verbatim builds the operational "how to bill" layer from CMS's own public words, and points to the licensed descriptor sets your encoder already holds. Code sets are the 2026 releases.
Coverage
"Will it be paid at all?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| NCDs -- National Coverage Determinations | CMS | Nationwide coverage rules | Carried |
| LCDs + billing articles -- Local Coverage Determinations (961) and their billing articles (2,159), every Medicare jurisdiction | MACs | Regional coverage and the exact diagnoses that support medical necessity | Carried |
Local coverage is carried for every Medicare jurisdiction. National coverage (NCDs) is nationwide. Individual Medicare Advantage plan policies are not covered; see the Medicare Advantage row below.
Payment
"How much, and on what basis?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| MPFS -- Physician Fee Schedule + RVUs / indicators | CMS | Pricing plus global periods, bilateral, and assistant-surgery flags | Carried |
| OPPS / APC -- Addendum A + B | CMS | Hospital outpatient pricing | Carried |
| IPPS / MS-DRG | CMS | Inpatient pricing | Carried |
| ASC payment | CMS | Ambulatory surgery center pricing | Carried |
| DMEPOS fee schedule | CMS | Durable medical equipment pricing | Carried |
| Clinical Lab Fee Schedule (CLFS) | CMS | Lab pricing | Carried |
| Ambulance fee schedule | CMS | Ambulance pricing | Carried |
| Drug fee schedule | CMS | Drug pricing | Carried |
| Nursing home and hospice base rates | CMS | The base payment rates for those settings | Carried |
Fee schedules and payment data are 2026 only. Earlier years are not covered.
Adjudication & remittance
"What happened to the claim?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Claims-processing rules -- the Claims Processing Manual, all 39 chapters | CMS | How claim lines are adjudicated | Carried |
| The appeals pathway -- redetermination → reconsideration → ALJ | CMS | The recourse path when a claim is denied | Carried |
| Remittance code lists (CARC / RARC) | X12 | The licensed code lists that explain a paid, reduced, or denied line. We carry what CMS itself says about those codes | Cited only |
The "what do I do about this denial" knowledge -- the claims-processing rules and the appeal path -- is public and in corpus. Only the licensed remittance code lists sit behind a license, so they are pointed to, never redistributed.
Medicaid
"What about Medicaid?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Federal Medicaid rules -- Title 42 of the Code of Federal Regulations (Medicaid parts) and Federal Register rules, 2010 on | CMS / NARA | The federal rules every state program works under | Carried |
| Claim filing deadline reference -- all 50 states | Verbatim reference table | How long you have to file a Medicaid claim in each state | Carried |
| New York state audit protocols (OMIG) | New York OMIG | What New York Medicaid auditors check | Carried -- NY |
| New York Medicaid Update articles -- a first set, for New York users | New York State Department of Health | New York Medicaid policy and billing updates, shown as a summary and a link | Carried -- NY |
| State Medicaid manuals and fee schedules, other than the New York items above | State Medicaid agencies | Each state's own billing rules and rates | Not covered |
Medicaid coverage is the federal rules, the 50-state filing deadline reference, and the New York items listed here. Other state Medicaid manuals and fee schedules are not covered.
Outside the archive
"What does Verbatim not cover?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Medicare Advantage rules -- the federal rules plans must follow, including the Managed Care manual | CMS | What every Medicare Advantage plan is required to do | Carried |
| Individual Medicare Advantage plan policies | Each plan | One plan's own coverage, prior authorization and payment rules | Not covered |
| Commercial plan policies | Each insurer | A commercial insurer's own coverage and payment rules | Not covered |
| Earlier versions of a rule | CMS | What a regulation, manual or fee schedule said in a past year. Regulations and manuals are the current text as we captured it in 2026; fee schedules are 2026 only | Not covered |
| Nursing home survey guidance | CMS | Surveyor guidance for nursing home inspections | Not covered |
"Not covered" here does not mean cited: these sources are simply outside the archive. When a question falls outside what Verbatim covers, it says so and offers a search of official .gov sources, clearly labeled as separate from our archive.
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