← Back to list
R13930CP: Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes
Act
by Dec 1, 2026
Effective date
Oct 1, 2026
Identified
Sep 12, 2026
Summary
CMS updated the FY 2027 Inpatient Prospective Payment System and Long-Term Care Hospital PPS rules for hospital discharges from October 1, 2026 through September 30, 2027, with MS-DRG Grouper and Medicare Code Editor version 44.0. CMS deleted 18 MS-DRGs and added 14, for a total of 768. Starting January 1, 2027, the temporary low-volume hospital criteria end, so a hospital must have fewer than 200 total discharges and be more than 25 road miles from the nearest IPPS hospital to qualify for the 25 percent adjustment, and the Medicare-dependent hospital program expires.
Get alerts when payers change rules like this one
We check Medicare/CMS - Transmittals and other payers every day and email you when a change matches your specialty and state.
Get Medicare/CMS - Transmittals alertsPolicy Monitoring is free. No card required.
What to do
by Dec 1, 2026 · 8 steps
01A hospital that wants the 25 percent low-volume adjustment for discharges on or after January 1, 2027 must have a written request received by its MAC by that date, with documentation that it continues to meet the discharge and mileage criteria.
02Already effective October 1, 2026: Discharges on or after that date are grouped with MS-DRG Grouper version 44.0 and edited with MCE version 44.0.
03Billing team: Use the ICD-10 MS-DRG V44.0 Definitions Manual on the CMS MS-DRG Classifications and Software webpage as the reference for the grouper logic.
04For immunotherapy cases in MS-DRG 018 with expanded access use, the provider may submit condition code 90 on the claim so the payment adjustment applies.
05For CAR T-cell or other immunotherapy purchased in the usual manner but used in a clinical trial of a different product, with ICD-10-CM code Z00.6 on the claim, enter billing note NTE02 'Diff Prod Clin Trial' on the electronic 837I claim, or the remark 'Diff Prod Clin Trial' on a paper claim.
06For a product provided at no cost, enter billing note 'PROD NO COST' on the 837I claim, or the remark 'PROD NO COST' on a paper or Direct Data Entry claim.
07Future change January 1, 2027: Hospitals that previously qualified for Medicare-dependent hospital status lose it and are paid on the Federal rate, and provider types 14 and 15 are no longer valid.
08Eligible former MDHs may apply for SCH status under certain conditions.
Codes mentioned
Z00.6
Original notice
R13930CP: Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes
cms.gov · Always check the source before changing claims.
Related changes
See all Medicare/CMS - Transmittals changes →R13969CP: Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS ChangesMediumEffective Oct 1, 2026 · CMS TransmittalR13800CP: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)MediumEffective Mar 19, 2025 · CMS TransmittalR13801CP: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)MediumEffective Jul 2, 2025 · CMS TransmittalR13802CP: NCD 20.40- Renal Denervation (RDN) for Uncontrolled HypertensionMediumEffective Oct 28, 2025 · CMS TransmittalBrowse every Medicare/CMS - Transmittals change in the policy list