Traditional MedicareBilling CodesHigh impact
R13978CP: October 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)
Medicare/CMS - Transmittals·CMS Transmittal
Effective date
Oct 1, 2026
We identified it
Sep 30, 2026
Summary
CMS implemented the October 2026 Hospital Outpatient Prospective Payment System (OPPS) update effective October 1, 2026, introducing 39 new Proprietary Laboratory Analyses (PLA) codes (0660U-0698U), 58 new Category III CPT codes, new HCPCS codes including G0685 for autism spectrum disorder assessment, and changes to existing codes such as CPT 1011T (photobiomodulation therapy) which is now payable after FDA approval. The Integrated Outpatient Code Editor (I/OCE) reflects these coding and APC assignment changes, with implementation deadline of October 5, 2026.
Action Required
By October 5, 2026: Billing team must update billing software and I/OCE data files to reflect all October 2026 OPPS changes. SPECIFIC ACTIONS: (1) Add 39 new PLA codes 0660U-0698U with correct status indicators and APC assignments per Table 1 in Attachment A; (2) Add 58 new Category III CPT codes with status indicators and APC assignments per Table 2; (3) Add new HCPCS code G0685 for algorithm-based autism spectrum disorder assessment with appropriate status indicator and APC per Table 5; (4) Delete HCPCS code C8010 and replace with CPT code 1091T per Table 4; (5) Update CPT code 1011T from status indicator E1 (non-payable) to payable status with new APC assignment per Table 6; (6) Update chapter 4 manual sections including Table of Contents (4), Modifier CA (4/20.6.7), Critical Care Services (4/160.1), and add new Trauma Activation Services section (4/160.2); (7) Verify all codes are loaded in billing system by October 5, 2026. Download OPPS Addendum B from CMS website for complete short descriptors and payment rates. Failure to update codes by implementation date will result in claim processing delays, denials for new codes, and incorrect reimbursement for recoded services. Notify all providers of coding changes, especially the transition from C8010 to CPT 1091T for carotid implant studies.