October 2026 OPPS update includes new codes, payment rates
CMS published the October 2026 update to the Outpatient Prospective Payment System (OPPS), which includes changes to Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) codes, status indicators (SI), and payment rates.
The American Medical Association CPT Editorial Panel established 39 new proprietary laboratory analysis codes (0660U–0698U). CMS added these codes to the October 2026 Integrated Outpatient Code Editor (I/OCE). The agency also implemented 58 new CPT Category III codes, adding codes 1054T–1111T to the October I/OCE.
Another key change is the addition of new CPT code 1091T, which describes the Category B Investigational Device Exemption clinical study associated with Javelin Medical’s carotid implants for permanent placement of common carotid artery filters. CMS deleted HCPCS code C8010 because it described the same procedure. The agency also established new HCPCS code G0685 for the algorithm-based assessment of the likelihood of autism spectrum disorder through analysis of eye-gaze data or other technology.
The October 2026 OPPS update includes many coding changes for drugs, biologicals and radiopharmaceuticals. CMS created six new HCPCS codes for several products receiving pass-through payment status. As this status ended for nine HCPCS codes on September 30, 2026, the agency changed their SIs from “G” to “K” or “N”. Other changes include 29 new codes, 10 deleted codes, 21 SI revisions, and three descriptor changes.
CMS updated the payment rate for HCPCS code Q5161 on July 20, 2026, retroactive to July 1, 2026. Medicare Administrative Contractors are to adjust claims for this code received from July 1 to July 21, 2026, within 30 days of the implementation date. Additionally, based on updated average sales price calculations, CMS revised payment rates for several drugs and biologicals from those published in the 2026 OPPS final rule. The updated rates are available in the October 2026 OPPS addenda.
For skin substitutes, CMS revised the long descriptors for several HCPCS Level II codes to include the parenthetical “add-on, list separately in addition to primary procedure,” retroactive to April 1, 2026. The agency also established eight new HCPCS codes for various skin substitute products, all assigned to SI “S1” or “N.”
Unless otherwise noted, the changes in this update took effect on October 1, 2026. Revenue integrity professionals should review the October 2026 OPPS update and addenda in full to identify relevant coding, billing, and payment changes.