October NCD coding update (R13968) is implemented; a related NCD 110.23 stem-cell coding instruction, R14035CP, was issued for April 5, 2027

Background

R13968 (Change Request 14464) is a quarterly maintenance update of ICD-10 coding conversions and other coding updates specific to NCDs, and CMS states that no policy is changed by these updates. It rescinded and replaced Transmittal 13910, issued August 14, 2026.

Who this affects

Hospitals and health systems billing Medicare Part A and B for services under the affected NCDs (cardiac positron emission tomography (PET), bone density 0554T-0558T, implantable cardioverter defibrillators (ICDs), aprepitant, Breyanzi, Oncomine 0648U) and transplant programs billing allogeneic stem cell transplant for myelodysplastic syndromes (MDS).

Why it matters

Once R14035CP is implemented on April 5, 2027, contractors will return claims for allogeneic hematopoietic stem cell transplantation (HSCT) for MDS that are not submitted on a valid type of bill (TOB), under a return to provider (RTP) edit effective for dates of service on or after March 6, 2024; the transmittal notes that such claims were previously denied. Inference: claims with the retrospective service dates in R13968 that denied before the update are adjusted only when the hospital brings them to its Medicare Administrative Contractor (MAC), because the transmittals tell contractors not to search for affected claims. The due dates in the playbook are recommended internal targets, not agency deadlines.

Required actions

• None directed at providers by date; the transmittals instruct MACs and shared-system maintainers. MACs are told not to search for affected claims and to adjust those brought to their attention (R13968, R14022OTN). That is an instruction to contractors, not a duty on providers; a provider that wants a claim adjusted brings it to the MAC (see the recommended actions).
• R14035CP: claims for the covered allogeneic HSCT for MDS must be submitted on a valid TOB; contractors will return to provider claims not on a valid TOB for dates of service on or after March 6, 2024, with April 5, 2027 implementation.

Implementation playbook

1. Confirm deployed October NCD edits match R13968 with NCD 110.23 removed, and retain vendor evidence. Owner: Coding. Due: 2026-11-20.
2. Identify claims with the retrospective service dates named in R13968 (for example 0554T-0558T diagnostic indications from January 1, 2024; C88.40 from December 4, 2025; 0648U from July 2026) that denied before the update, and bring them to the MAC's attention, since MACs adjust only claims brought to them. Owner: Revenue Cycle. Due: 2026-12-04.
3. Map R14035CP (allogeneic HSCT for MDS, effective June 30, 2026 dates of service, TOB 13X and 85X payable from October 1, 2026, RTP edit for invalid TOB) to the transplant program's billing and decide how affected claims are held or rebilled before April 5, 2027 implementation. Owner: Revenue Cycle with the transplant program (Clinical Operations). Due: 2027-01-15.
4. Confirm clearinghouse and billing-system readiness for the April 5, 2027 releases (R14035CP and the separate April NCD coding update R14022OTN). Owner: IT. Due: 2027-03-15.
5. Sample post-implementation claims and record results. Owner: Compliance. Due: 2027-04-30.

Not established

The R13968 ZIP spreadsheets were not opened. Whether R14035CP covers every requirement removed from R13910 (business requirements 14464.4 through 14464.4.1.1) was not compared line by line; the earlier R13910 was not retrieved. No Medicare Learning Network (MLN) Matters article for CR 14645 was checked.

Sources

• CMS Transmittal R13968OTN (CR 14464)
• CMS Transmittal R14035CP (CR 14645)
• CMS Transmittal R14022OTN (CR 14653)
• CMS 2026 Transmittals