Noridian October coding updates change FFR, infusion-pump and SAD billing
Oct 11, 2026 edition · GC-2026-0201 · Published 2026-10-11 · Version 3 · Final
Noridian's October article updates change selected FFR codes, infusion-pump drug prices, and a self-administered-drug exclusion entry. The accompanying operative articles preserve clinical documentation, trial, and administration-route conditions beyond the updated code tables.
What happened
The October 1 coding notice adds 1086T, 1087T, and 1104T to A58095 for non-invasive fractional flow reserve. A55239 revision 27 separately updates Prialt and ropivacaine pricing for October through December, while A53032 revision 48 removes J1941 from its excluded-code list. Another notice updates article-specific ICD-10 tables. These are different coding, pricing, and exclusion changes, rather than a single new coverage benefit or permission to apply a price without checking the service date, drug unit, and applicable article.
A58095 requires the referring/ordering physician's name and NPI and clinical/CCTA information supporting the post-imaging FFR analysis, including the analysis report. A55239 retains medical-necessity conditions, unsuccessful less-invasive treatment, specialist evaluation, and a documented preliminary intrathecal or epidural trial. A53032 continues route-specific JA/JB rules for marked drugs with multiple administration routes, including medical necessity of the route and denial consequences for missing required modifiers. A revised code or removal from the exclusion table therefore does not dispense with the remaining clinical, benefit, and billing conditions.
Scope and timing
- Authority status
- Final
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Revenue Cycle, Compliance, Clinical Operations
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-01
- Date type
- effective
Why it matters
Assess the development with the operational owner before changing applicable policies or payment workflows.
Recommended action
Update affected code and price tables and validate billing against each complete policy and benefit rule.
Implementation playbook
- Update affected code and price tables and validate billing against each complete policy and benefit rule. Revenue Cycle · Due 2026-10-09
- Record the applicability assessment and validate the affected workflow with its operational owner. This is an internal review target, not an additional statutory deadline. Compliance · Due 2026-10-12
Sources
- October CPT and HCPCS billing article updateOfficial · Noridian Medicare · 2026-10-01 · Source review 2026-10-11
- Implantable infusion pumps article R27Official · Noridian Medicare · 2026-10-01 · Source review 2026-10-11
- Self-administered drug exclusion list R48Official · Noridian Medicare · 2026-10-01 · Source review 2026-10-11
- October ICD-10 billing article updatesOfficial · Noridian Medicare · 2026-10-01 · Source review 2026-10-11
- Operative Noridian billing article A58095Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- Operative Noridian billing article A55239Official · CMS Medicare Coverage Database / Noridian · Source review 2026-10-11
- Operative Noridian billing article A53032Official · CMS Medicare Coverage Database / Noridian · 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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