Traditional MedicareBilling CodesHigh impact
R13836CP: July 2026 Update of the Ambulatory Surgical Center (ASC) Payment System
Medicare/CMS - Transmittals·Urology, Ophthalmology, Pharmacy·CMS Transmittal
Effective date
Jul 1, 2026
We identified it
Jun 25, 2026
Summary
CMS implemented a July 2026 update to the Ambulatory Surgical Center (ASC) payment system, introducing one new pass-through device (C1609), two new urology procedure codes (C8014 and revised C9761), payment indicator changes for four procedures, ten new drug/biological codes, and payment status changes for five existing drug codes. Billing teams must update systems to reflect new code assignments, payment indicators, and ASC fee schedules effective July 1, 2026.
Action Required
By July 1, 2026: (1) Billing team must update ASC billing software with new July 2026 ASC Fee Schedule File, ASC Drug File, ASC Code Pair file, and ASC Payment Indicator (PI) File provided by CMS. (2) Add new device code C1609 to pass-through device inventory with appropriate payment indicator. (3) Add new urology procedure codes C8014 and update existing code C9761 descriptor in billing system. (4) Update payment indicators: CPT 0996T to E5 (retroactive to January 1, 2026—do not bill), CPT 0730T per Table 5, HCPCS J1741 to K2 (retroactive March 11, 2026), Q5156 to K2 (retroactive April 1, 2026), J3403 to K2 (retroactive April 1, 2026), and J2993 to Y5 (effective July 1, 2026). (5) Add ten new drug/biological codes from Table 6 with K2 payment indicator. (6) Add two existing drug codes to pass-through status with K2 indicator per Table 7. (7) Update three drug code descriptors per Table 9. (8) Audit all claims billed with 0996T since January 1, 2026 for potential denials and recoupment. Failure to update systems will result in claim denials, payment delays, and potential overpayments requiring refunds.