October 2026 ASC Payment System Update

10 New Category III Codes, 12 New Pass-Through Drug Codes and 8 New Skin Substitute Codes

Rcmaxis Billing & Policy Update  ·  Posted October 14, 2026  ·  Effective: October 01, 2026 (implementation October 05, 2026)

Summary of the Rule or Edit Change

CMS issued Transmittal 13983 (Change Request 14634) on October 8, 2026, describing the October 2026 update to the Ambulatory Surgical Center (ASC) Payment System. Changes are effective October 1, 2026, and contractors implemented them October 5, 2026. CMS releases an October ASC fee schedule file, drug file, code pair file and payment indicator file with it, and it applies to ASCs billing through the A/B MACs.

On the procedure side, CMS is implementing 10 new Category III CPT codes that the AMA released in early August 2026. They include 1054T (ultrasonic propulsion of residual stone fragments after lithotripsy), 1056T (cochlear infusion of a gene therapy agent), 1062T (transcervical intratubal artificial insemination), 1069T and 1070T (extremity cryocompression), 1081T (lymph node to vein microvascular anastomosis), 1084T (suprachoroidal scaffold allograft) and the carotid and knee scaffold codes 1091T, 1092T and 1093T. CPT 1091T replaces HCPCS code C8010, which CMS is deleting because the new code describes the same carotid artery filter placement. Descriptors for HCPCS C1982, C9797 and C8004, covering vascular embolization with a pressure-generating catheter, were also revised.

The drug section follows the same structure as the hospital outpatient update, with its own counts. CMS created 12 new HCPCS codes for drugs and biologicals that receive pass-through status, deleted 10 drug codes as of September 30, changed the payment status of 21 codes effective October 1 and one more effective July 1, and revised descriptors on three codes. Most non-pass-through drugs are paid at ASP plus 6 percent, updated quarterly, and CMS posts restated rates the first day of each quarter so providers can resubmit affected claims.

Skin substitutes are in this update too. CMS created 8 new Level II codes, including A2046, A2047, A2049, Q4207, Q4223 and Q4243 as add-on codes billed per square centimeter, and revised the descriptors of 5 existing codes retroactive to April 1, 2026 to add the phrase "add-on, list separately in addition to primary procedure." Last, the descriptor for C9812 now lists Stimuplex needles as a qualifying non-opioid device, with temporary additional payment effective April 30, 2026, capped at an estimated average of 18 percent of the OPD fee schedule amount for the procedure.

Action Required for Billing Teams

ASCs get paid per case, so a charge master that's a week behind costs real money. Say 40 claims averaging $2,500 each sit on hold because a deleted code or a missing new one rejected them. That's $100,000 in unpaid claims until the fix is loaded.

For the hospital side of this same release, see our update on the October 2026 OPPS quarterly update, and for the proposed 2027 rates, our CY 2027 OPPS and ASC proposed rule summary and ASC billing guide.