On April 10, 2009, CMS issued a transmittal on billing routine cost of clinical trials, in which it announced that it is eliminating the need for differentiation between a diagnostic clinical trial service and a therapeutic clinical trial service. CMS also is providing that, for beneficiaries enrolled in a managed care plan, institutional providers must not bill outpatient clinical trial services and non-clinical trial services on the same claim. The policy is effective July 10, 2009.