This bill, called the No Unreasonable Payments, Coding, Or Diagnoses for the Elderly Act (the “No UPCODE Act”), changes how the government pays Medicare Advantage plans so payments better match patients’ real health needs. It tells CMS to base payments on two years of medical diagnoses when available, instead of just one year. It also blocks the use of diagnoses pulled only from chart reviews or health risk assessments, which are not from regular doctor visits. Starting in 2026, CMS must also check for differences in how Medicare Advantage and traditional Medicare record diagnoses, publicly report what it finds, and adjust payments to account for any gaps.

Key points

• Who is affected: People in Medicare Advantage, Medicare Advantage plans, and CMS.
• What changes: Use two years of diagnosis data; exclude diagnoses taken only from chart reviews and health risk assessments; yearly review and public reporting of coding differences; payment adjustments can be made by plan or contract.
• When: Applies for 2026 and each year after.