Coding Update

Coding Update | October 2026 NCCI PTP, MUE and HCPCS Quarterly Update: 4,249 New Edit Pairs and New MUEs - Effective Date: October 01, 2026

Rcmaxis Billing & Policy Update · Posted September 27, 2026 · Effective: October 01, 2026

Version 32.3 practitioner PTP edits add 4,249 code pairs and delete 14. The practitioner MUE table adds 51 codes and revises 31, including 96127 at 4 units per day. Medicare systems load the October HCPCS file on October 5.

Summary of the Rule or Edit Change

CMS posted the October 1, 2026 quarterly NCCI files in early September: the MUE tables on September 1 and the procedure-to-procedure (PTP) edits, version 32.3 (v323r0), on September 2. Both apply to claims with dates of service on or after October 1, 2026.

Here's what changed in the practitioner files, counted from CMS's quarterly change files:

PTP edits: 4,249 code pairs added, 14 deleted and 7 modifier indicator changes. Most of the new pairs involve recent Category III codes (0928T through 0947T) and proprietary laboratory analysis codes such as 0523U and 0530U, so practices billing those codes will feel it most.
MUE additions (51): mostly new PLA codes (0552U through 0574U), new drug codes such as J0013, J0162, J1073 and J2516, device codes C1740 and C1742, and M0235 through M0238.
MUE revisions (31): the lower extremity revascularization codes 37255 through 37299, several drug codes (including J2326, J7172, J9329 and J9380), and 96127, the brief emotional or behavioral assessment code, now at 4 units per date of service.
MUE deletion (1): 0585U.

On the HCPCS side, CMS's October 2026 HCPCS Quarterly Update Reminder (Change Request 14444, Transmittal R13784CP, issued May 27, 2026) sets October 5, 2026 as the implementation date for the October file of new, revised and discontinued codes. CMS updated the downloadable October alpha-numeric file on its HCPCS Quarterly Update page in September.

The NCCI files take effect by date of service, not the date you submit the claim. A claim you send on October 10 for a September 29 visit is edited under the July files.

Action Required for Billing Teams

Load v32.3 PTP and the October MUE tables before October 1 dates of service go out. Confirm with your clearinghouse or scrubber vendor that the update is live, and test a known new edit pair.
Check 96127 billing. Behavioral health and primary care practices that run several screening instruments at one visit should confirm they stay within 4 units per date of service, or document why more are medically necessary.
Review Category III and PLA codes. If you bill any 0928T to 0947T code or a PLA code, check the new pairs before billing them with other services on the same day.
Map new drug codes. Replace unlisted drug codes (J3490, J3590) with the new specific J-codes where they apply, and set up units against the new MUEs.
Hold claims with new HCPCS codes until October 5. Claims using codes new to the October file can reject if they reach Medicare before its systems load the update.

Verifiable References

CMS. Medicare NCCI Procedure to Procedure (PTP) Edits. cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncc...
CMS. Medicare NCCI Medically Unlikely Edits (MUEs). cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncc...
CMS. HCPCS Quarterly Update. cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update
CMS. Transmittal R13784CP (CR 14444): October 2026 HCPCS Quarterly Update Reminder. cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13784cp

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