CMS revises the October NCD coding update and moves stem-cell changes to April 2027
Oct 11, 2026 edition · GC-2026-0133 · Published 2026-10-11 · Version 3 · Final
R13968 replaces the earlier NCD coding release, removes stem-cell requirements, and retains retrospective corrections without changing coverage policy.
What happened
The September 24 transmittal rescinds R13910 and removes the stem-cell business requirements for a separate April 2027 change request. October 1 service-date effectiveness and October 5 implementation otherwise remain, subject to the individual retrospective dates. Remaining cardiac PET instructions change tracer parameters and edits, while bone-density codes 0554T through 0558T are added for diagnostic indications from January 1, 2024, with corresponding frequency and cost-sharing edits. The bone-density additions expressly exclude monitoring indications.
Other retained requirements add implantable-defibrillator procedure codes from April 2026, revise aprepitant-related coding, add C88.40 for Breyanzi from its December 4, 2025 FDA approval date, and add 0648U for the Oncomine test from July 2026. These dates are specific to their requirements, rather than one blanket October coverage expansion. MACs must adjust affected claims brought to their attention without searching previously processed claims. CMS characterizes the release as coding maintenance, with NCD policy changes left to the established determination process.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Revenue Cycle, Coding, IT, Compliance
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-05
- Date type
- implementation
Why it matters
Verify the implemented release scope and review affected claims without treating the removed stem-cell requirements as active October edits. Code maintenance alone does not expand underlying coverage criteria.
Recommended action
Coding and IT should reconcile deployed CR 14464 tables with the replacement scope; Revenue Cycle should identify affected retrospective claims for MAC attention and retain outcomes. Verify actual coverage criteria before rebilling.
Implementation playbook
- Reconcile deployed edits with the replacement transmittal and remove deferred stem-cell changes from the October scope. Coding · Due 2026-10-12
- Test applicable claim cases against actual NCD criteria and identify retrospective adjustments for MAC attention. Revenue Cycle · Due 2026-10-16
- Retain vendor and contractor implementation evidence; do not treat the future April CR as released. IT · Due 2026-10-16
Sources
- Transmittal 13968, Change Request 14464Official · Centers for Medicare and Medicaid Services · 2026-09-24 · Source review 2026-10-11
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
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