Traditional MedicareBilling CodesMedium impact
R13910OTN: International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)- October 2026
Medicare/CMS - Transmittals·Cardiology, Nuclear Medicine, Radiology +1 more·CMS Transmittal
Effective date
Oct 1, 2026
We identified it
Aug 15, 2026
Summary
This CMS transmittal provides quarterly maintenance updates to ICD-10 coding conversions and coding revisions specific to National Coverage Determinations (NCDs), effective October 1, 2026. The policy rescinds the previous May 2026 transmittal and removes NCD 250.4 (Treatment of Actinic Keratosis) from the change request. No coverage policy changes are included—only coding and system edits are being updated for specific NCDs including PET perfusion imaging, bone density studies, and related procedures.
Action Required
By October 1, 2026: Billing team and IT contractors must complete the following system updates: (1) Update edits for NCD 220.6.1 (PET Perfusion of the Heart) to make existing edits overridable; (2) Create parameter screens (PARM) for tracer codes in Reason Codes 32438 and 32440 that allow MAC updates; (3) Add CPT codes 78430-78434 to edit logic for Reason Code 32438; (4) Load HCPCS tracer codes A9598 (effective 1/1/2018) and A9611 (effective 04/01/2025) into PARM with historical comments; (5) Add CPT codes 0554T-0558T as payable for NCD 150.3 (Bone Mineral Density Studies) effective January 1, 2024, and update frequency edits; (6) Waive coinsurance and deductible for CPT codes 0554T-0558T; (7) Update MBD/NGD extract and HUQA provider query screens to display Bone Density Service Next Eligibility Date for new CPT codes. Shared-system maintainers (FISS, MCS, VMS, CWF) and A/B MACs must coordinate implementation. Claims submitted without these updates will be subject to edit denials or improper frequency denials.