← Back to list
R13969CP: Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes
Effective date
Oct 1, 2026
Identified
Sep 30, 2026
Summary
Inpatient hospital (IPPS) and long-term care hospital (LTCH) payment rules are updated for Fiscal Year 2027, covering discharges from October 1, 2026 through September 30, 2027. The ICD-10 MS-DRG Grouper Version 44.0 applies to discharges on or after October 1, 2026, with 18 MS-DRGs deleted and 14 new ones finalized for a total of 768. Hospitals that previously qualified for Medicare-dependent hospital status lose it on January 1, 2027 and are paid on the Federal rate alone.
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
Action · 5 steps
01Already effective October 1, 2026: Inpatient hospital claims for discharges on or after that date are paid under the FY 2027 rates, factors and policies, and the MS-DRG Grouper Version 44.0 and ICD-10 MCE Version 44.0 apply to them.
02For MS-DRG 018 cases using expanded access immunotherapy, the provider may submit condition code 90 so the payment adjustment applies.
03For a clinical trial of a different product with diagnosis Z00.6, the provider may enter billing note NTE02 'Diff Prod Clin Trial' on the 837I claim so the adjustment is not applied.
04Future date January 1, 2027: Hospitals that previously qualified for Medicare-dependent hospital status are paid based solely on the Federal rate, and the low-volume hospital rules revert to the criteria in effect before the temporary changes.
05Check current applicability of these FY 2027 rules before relying on them.
Codes mentioned
Z00.6
Original notice
R13969CP: 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 →R13930CP: Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS ChangesHighEffective 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