Coders: Are You Ready for Oct. 1?
- By Renee Dustman
- In Billing
- September 29, 2026
- No Comments
Your guide to CMS’ fourth quarter coding and payment files.
We in the industry always say that nothing stays the same in the business of healthcare. If anyone ever doubts this, just show them this list of updated coding and payment files the Centers for Medicare & Medicaid Centers (CMS) released in September — all of which are effective Oct. 1.
CMS posts quarterly updates to several different files that affect the coding and billing of Medicare claims. For example:
- National Correct Coding Initiative (NCCI) Provider-to-Provider (PTP) Practitioner and Hospital Outpatient Edits
- Each of these files contains a list of code edits Medicare Administrative Contractors (MACs) use to identify services that are considered integral to each other (bundled) and should not be paid separately.
- Medicare Severity-Diagnosis Related Groups (MS-DRGs)
- This is a classification system for inpatient discharges that adjusts payments under the Inpatient Prospective Payment System based on weighting factors assigned to each DRG.
- Average Sales Price (ASP) Drug Payment Limit Files
- Part B drug makers report ASP data for Part B-covered drugs and biologicals. Medicare bases payments for Part B drugs on 106 percent of the ASP. Drugs are identified by their National Drug Code (NDC).
- Clinical Laboratory Fee Schedule (CLFS) identifies the codes and payment rates for clinical diagnostic laboratory tests.
Make sure the people managing your practice’s revenue cycle are using these updated files to ensure proper adjudication of Medicare claims.
Links to Quarterly Updates
Below are links to October 2026 quarterly update files. We have included the release dates because CMS is known for updating updates. Always confirm that you are using the most current files.
Sept. 2
Medicare NCCI Hospital and Practitioner PTP edits v323r0:
Sept. 8
MS-DRG Definitions Manual and Software, including ICD-10 MS-DRG Definitions Manual Files v44:
See what the changes are in MLN Matters® article MM14519.
ICD-10 files and fiscal year (FY) 2027 ICD-10 Coding Guidelines:
https://www.cms.gov/medicare/coding-billing/icd-10-codes
https://www.cms.gov/files/document/fy-2027-icd-10-cm-coding-guidelines.pdf
Any changes to the ICD-10-CM code set affect national cover determinations (NCDs), so be sure to check those too. CMS released MLN Matters® article MM14464 on September 24, which identifies relevant coding changes to six NCDs that are effective Oct. 1, 2026. See also MM14614 for a list of laboratory NCDs affected by the FY 2027 update.
Sept. 17
October 2026 Medicare Part B Payment Limit Files and NDC-HCPCS Crosswalk:
https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files
Sept. 18
ASP Drug Payment Limit Files and October 2026 Medicare Part B Payment Limit Files:
https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files
https://www.cms.gov/files/zip/october-2026-medicare-part-b-payment-limit-files-final.zip
Sept. 22
CLFS 26LABQ4 files:
https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs/files
See MLN Matters® article MM14589 for details of this update.
Sept. 23
October 2026 Alpha-Numeric HCPCS File:
https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update
This file has been updated at least once since originally posted on Aug 18. See the AAPC blog post “CMS Finalizes October 2026 HCPCS Level II Changes” for information about changes to this code set for services and supplies.
Never Miss an Update Again
If this list has your head spinning, AAPC has the answer! Codify by AAPC eliminates the need for coders to worry about whether they are using the most up-to-date files. The online code search and lookup resource is updated in real time, so you can always be confident in your coding.
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