2027 Medicare HCPCS releases and $0.270 clotting-factor fee have separate service and system dates
Sep 20, 2026 edition · GC-2026-0014 · Published 2026-09-20 · Version 2 · Final
The 2027 clotting-factor furnishing fee starts with January 1 services, while CMS schedules separate effective and implementation dates for all four HCPCS quarters.
What happened
CMS issued R13937CP on August 27 under CR 14580 to set the 2027 clotting-factor furnishing fee at $0.270 per unit. The fee applies to dates of service beginning January 1, 2027; contractor implementation is January 4. CMS includes the furnishing fee in the published national clotting-factor payment limits. Where the payment limit is absent from the average-sales-price or not-otherwise-classified pricing files and separate payment for the factor is allowed, contractors add the furnishing fee separately. The fee is separately payable only when its costs are not already paid through another payment system, so the update does not authorize duplicate reimbursement.
The separate August 27 R13938CP, CR 14586, gives the download and implementation instructions for the complete 2027 quarterly HCPCS files, including existing, new, revised and discontinued codes. Effective dates are January 1, April 1, July 1 and October 1; the corresponding implementation dates are January 4, April 5, July 5 and October 4, 2027. CMS expects files approximately six weeks before each quarter and directs contractors to obtain them through its cloud process after notification, test and load the releases, and follow instructions for corrected files. This annual instruction replaces the former quarterly change-request process; it does not itself establish a new coverage policy for every code in the files.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Revenue Cycle, IT, Coding, Finance
- Responsible owner
- Revenue Cycle
- Recorded date
- 2027-01-04
- Date type
- implementation
Why it matters
A January 4 systems milestone does not move the furnishing fee’s January 1 service applicability or the effective dates of later HCPCS quarters. Pricing and code-file ownership must cover the full year.
Recommended action
Assign pharmacy/revenue-cycle review of the $0.270 furnishing fee for January 1 onward services, checking whether it is already included in the factor payment limit. Schedule HCPCS file receipt, testing and implementation for each quarter and retain separate effective-date and systems-date controls.
Sources
- Transmittal R13938CP, change request 14586, instructions for downloading the HCPCS files for the January, April, July and October 2027 quarterly releasesOfficial · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-09-06
- Transmittal R13937CP, change request 14580, annual clotting factor furnishing fee update 2027Official · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-09-06
- R13937CP complete CMS transmittalOfficial · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-10-15
- R13938CP complete CMS transmittalOfficial · Centers for Medicare & Medicaid Services · 2026-08-27 · Source review 2026-10-15
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