August and September 2026 Medicare Updates

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Published on

Wednesday, October 7, 2026

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Medicare Transmittals & MLN Articles

August 7, 2026: MLN MM14544: Inpatient Rehabilitation Facility Prospective Payment System: FY 2027 Web Pricer Update

Make sure your billing staff knows about FY 2027 IRF Prospective Payment System updates (rural transition policy and wage index cap), effective October 1, 2026. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14544-inpatient-rehabilitation-facility-prospective-payment-system-fy-2027-web-pricer-update.pdf">https://www.cms.gov/files/document/mm14544-inpatient-rehabilitation-facility-prospective-payment-system-fy-2027-web-pricer-update.pdf</a>

August 10, 2026: MLN MM14519: Medicare Severity Diagnosis-Related Groups Subject to Inpatient Prospective Payment System Replaced Devices Policy: FY 2027 Update

CMS reduces IPPS payment for certain MS-DRGs when a hospital replaced an implanted device at no cost or with a credit equal to 50% or more of its replacement cost. CMS adds new MS-DRGs to the list when they include procedures assigned to an MS-DRG previously on the list. Effective October 1, 2027 8 MS-DRGs are being deleted from the list (MS-DRG 258, 259, 260, 261, 262, 466, 467, and 468) and 3 new MS-DRGs are being added to the list:

210: Cardiac Pacemaker Revision or Device Replacement with MCC

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211: Cardiac Pacemaker Revision or Device Replacement without MCC

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449: Revision of Hip or Knee Replacement.

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<a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14519-medicare-severity-diagnosis-related-groups-subject-inpatient-prospective-payment-system.pdf">https://www.cms.gov/files/document/mm14519-medicare-severity-diagnosis-related-groups-subject-inpatient-prospective-payment-system.pdf</a>

August 14, 2026: MLN MM14537: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (1 of 2)

NCDs with coding changes to be implemented January 4, 2027 include:

NCD 90.2 – Next Generation Sequencing (NGS),

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis,

NCD 150.3 – Bone (Mineral) Density Studies,

NCD 220.4 – Mammograms,

NCD 250.4 – Treatment of Actinic Keratosis, and

NCD 270.3 – Blood-Derived Products for Chronic Non-Healing Wounds.

<a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14537-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-1-2.pdf">https://www.cms.gov/files/document/mm14537-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-1-2.pdf</a>

August 18, 2026: MLN MM14570: ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (2 of 2)

NCDs with coding changes to be implemented January 4, 2027 include:

NCD 20.30 – Microvolt T-Wave Alternans (MTWA),

NCD 20.4 – Implantable Cardioverter Defibrillators (ICDs),

NCD 190.3 – Cytogenetic Studies,

NCD 220.6.17 – Positron Emission Tomography (FDG) for Oncologic Conditions,

NCD 260.1 – Adult Liver Transplantation, and

NCD 260.5 – Intestinal and Multi-Visceral Transplantation.

<a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14570-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-2-2.pdf">https://www.cms.gov/files/document/mm14570-icd-10-other-coding-revisions-national-coverage-determinations-january-2027-update-2-2.pdf</a>

August 25, 2026: MLN MM14569: Clinical Laboratory Fee Schedule & Clinical Laboratory Improvement Amendments HCPCS Codes, Waived Tests & Reasonable Charge Payments: October 2026 Quarterly Update

Make sure your bill staff knows about Clinical Laboratory Fee Schedule (CLFS) updates, effective October 1, 2026 including annual and quarterly CLIA edits, new waived test updates, and new and deleted CPT codes. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14569-clinical-laboratory-fee-schedule-clinical-laboratory-improvement-amendments-hcpcs-codes.pdf">https://www.cms.gov/files/document/mm14569-clinical-laboratory-fee-schedule-clinical-laboratory-improvement-amendments-hcpcs-codes.pdf</a>

September 2, 2026: MLN MM14581: National Coverage Determination 210.3: Colorectal Cancer Screening Tests – Non-Invasive Biomarker Testing

Effective June 8, 2026, CMS determined non-invasive biomarker screening tests are appropriate for colorectal cancer (CRC) screening based on specific criteria (Aged 45-85, asymptomatic, at average risk). <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm-14581-national-coverage-determination-210-3-colorectal-cancer-screening-tests-non-invasive.pdf">https://www.cms.gov/files/document/mm-14581-national-coverage-determination-210-3-colorectal-cancer-screening-tests-non-invasive.pdf</a>

September 4, 2026: MLN MM14553: Medicare Secondary Payer Claim Processing for Certain Claim Adjustment Reason Codes

Key update for your billing staff is MACs will return certain claims to you if they determine that Medicare can’t process them. They will continue to identify the reason for the return on the remittance advice. Providers will have the chance to correct returned claims and, in many cases, resubmit them to the primary payer or Medicare for re-processing. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14553-medicare-secondary-payer-claim-processing-certain-claim-adjustment-reason-codes.pdf">https://www.cms.gov/files/document/mm14553-medicare-secondary-payer-claim-processing-certain-claim-adjustment-reason-codes.pdf</a>

September 14, 2026: MLN MM14592: Inpatient & Long-Term Care Hospital Prospective Payment Systems: FY 2027 Changes

Make sure your billing staff is aware of the FY 2027 updates, for example, CMS deleted 18 MS-DRGs and finalized 14 new MS-DRGs, decreasing the number of MS-DRGs by 4 to 768. Several of the new MS-DRGs have been added to the list of MS-DRGs subject to the post-acute care transfer policy. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14592-inpatient-long-term-care-hospital-prospective-payment-systems-fy-2027-changes.pdf">https://www.cms.gov/files/document/mm14592-inpatient-long-term-care-hospital-prospective-payment-systems-fy-2027-changes.pdf</a>

October 1, 2026: MLN MM14589: Hospital Outpatient Prospective Payment System: October 2026 Update

Make sure your billing staff knows about CPT proprietary laboratory analysis (PLA) coding changes, new Category III CPT and HCPCS codes, ambulatory payment classification (APC) assignment, descriptor, and status indicator changes, drugs, biologicals and radiopharmaceuticals updates, skin substitute products updates, and qualifying non-opioid treatments for pain relief. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/mm14589-hospital-outpatient-prospective-payment-system-october-2026-update.pdf">https://www.cms.gov/files/document/mm14589-hospital-outpatient-prospective-payment-system-october-2026-update.pdf</a>

Coverage Updates

August 7, 2026: RAPID Coverage Pathway (CMS-3487-NC)

CMS issued a proposed procedural notice outlining a faster way for manufacturers to get new devices covered by Medicare: the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway. According to a CMS Fact Sheet, “this new Medicare coverage pathway will accelerate beneficiary access to eligible Class II FDA-designated Breakthrough Devices participating in FDA’s Total Product Life Cycle Advisory Program (TAP) and to eligible Class III FDA-designated Breakthrough Devices (regardless of TAP participation.)

CMS is accepting comments by October 13, 2026.

Related CMS Fact Sheet: <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/newsroom/fact-sheets/regulatory-alignment-predictable-immediate-device-coverage-pathway-cms-3487-nc-procedural-notice">https://www.cms.gov/newsroom/fact-sheets/regulatory-alignment-predictable-immediate-device-coverage-pathway-cms-3487-nc-procedural-notice</a>

RAPID Coverage Pathway Infographic: <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/rapid-coverage-pathway-infographic.pdf">https://www.cms.gov/files/document/rapid-coverage-pathway-infographic.pdf</a>

September 10, 2026: TAVR Final Decision Memo for Aortic Stenosis and New Tracking Sheet for Aortic Regurgitation

CMS published the Transcatheter Aortic Valve Replacement (TAVR) Final Decision Memo (CAG-00430R2). The NCD has been updated to cover TAVR for symptomatic severe aortic valve stenosis (or aortic stenosis (AS)) without coverage with evidence development (CED) requirement, expand coverage of TAVR to asymptomatic severe AS with CED, and revise coverage criteria related to pre-procedural patient assessment, intraoperative requirements, and operator and hospital procedural volume requirements. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=321">https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=321</a>

Also on September 10, 2026, CMS initiated a new national coverage analysis (NCA) for TAVR for aortic regurgitation. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324">https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324</a>

The NCA public comment period ends October 10,2026 and the proposed Decision Memo due date is March 10, 2027. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324">https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=324</a>

September 23, 2026: National Coverage Analysis: Screening for Hepatitis C Virus (HCV) in Adults

Currently, NCD 210.13 covers screening for beneficiaries who meet one of two conditions: adults at “high risk” for HCV infection or adults born between 1945 and 1965. CMS has received five formal requests to reconsider the NCD. CMS indicates the NCD analysis will align with the scope of the requests and focus on screening HCV in adults aged 18 to 79, as recommended by the US Preventive Services Task Force (USPSTF). The public comment period ends October 23, 2026. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=325">https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=325</a>

September 2026: CMS National Coverage Determination Dashboard Updated

CMS notes in this updated dashboard that “At-A-Glance” there are three open NCDs, five NCDs have been finalized in the last twelve months, there are no pending Transitional Coverage for Emerging Technologies (TCETs) and eleven NCDs on their wait list. <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/files/document/ncddashboard.pdf">https://www.cms.gov/files/document/ncddashboard.pdf</a>

Other Updates

August 24, 2026: $144 Million to Improve Mental Health, Substance Abuse, Emergency and Maternal Care and Expand the Healthcare Workforce in Alabama

This investment is being delivered through the Rural Health Transformation Program (RHTP). According to the CMS Press Release, “this investment will support 138 grants to expand access to care, modernize healthcare technology and infrastructure and strengthen the rural healthcare workforce.” You can read more about this funding in the CMD Press Release at <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/newsroom/press-releases/trump-administration-announces-144-million-improve-mental-health-substance-abuse-emergency-maternal">https://www.cms.gov/newsroom/press-releases/trump-administration-announces-144-million-improve-mental-health-substance-abuse-emergency-maternal</a>.

September 16, 2026: Adjustment to the Amount in Controversy Threshold Amounts for CY 2027

CMS published a notice in the Federal Register announcing the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. Effective for requests for ALJ hearings and judicial review filed on or after January 1, 2027, the AIC threshold amounts are $200 (up from $190 in 2026) and for ALJ hearings $2,000 (up from $1,960 in 2026) for judicial review. <a target="_blank" rel="noopener noreferrer" href="https://www.govinfo.gov/content/pkg/FR-2026-09-16/pdf/2026-19016.pdf">https://www.govinfo.gov/content/pkg/FR-2026-09-16/pdf/2026-19016.pdf</a>

September 30, 2026: CMS Releases Q2 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPR) for Short Term Acute-Care hospitals.

CMS released the Q2 FY 2026 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals on September 30th. In the Thursday, October 1, 2026 edition of MLN Connects, CMS notes providers can use this report to spot billing patterns that many need review or improvement, identify areas that may need closer monitoring or internal audits, find services that may be under-coded or over-coded, and track trends like longer patient stays. You can find how to get your PEPPER and more information about the report in MLN Connects newsletter at <a target="_blank" rel="noopener noreferrer" href="https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-october-1-2026">https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-october-1-2026</a>.

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Article Author: Beth Cobb, RN, BSN, ACM, CCDS

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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