What Changed in the October 2026 HCPCS Update
The October 2026 HCPCS file took effect on October 1, 2026. It has 45 new codes, 15 deleted codes and 12 changed descriptions. CMS updates Level II codes every quarter, on January 1, April 1, July 1 and October 1.
The date of service decides which code you use, not the date you send the claim. A deleted code is valid up to September 30, 2026. For a visit on or after October 1, it will be rejected or denied, often as CO-181 (code not valid on the date of service).
Deleted codes and what to use now
Most of the deleted drug codes came back with a smaller unit. The dose is the same, but the number of units on the claim goes up. If you gave 100 mg of leucovorin, you used to bill J0640 × 2. From October 1 you bill J0643 × 100. Billing the old number of units would pay only a fraction of the drug's cost.
| Deleted Sept 30, 2026 | Code for the same item from Oct 1 | Units |
|---|---|---|
| J0640 Injection, leucovorin calcium, per 50 mg | J0643 (1 mg) | × 50 (1 old unit = 50 new units) |
| J1941 Injection, furosemide (furoscix), 20 mg | J1947 (1 mg) | × 20 (1 old unit = 20 new units) |
| J1953 Injection, levetiracetam, 10 mg | J1957 (5 mg) J1958: Injection, levetiracetam in sodium chloride, 5 mg | × 2 (1 old unit = 2 new units) |
| J7514 Mycophenolate mofetil (myhibbin), oral suspension, 100 mg | J7530 (5 mg) | × 20 (1 old unit = 20 new units) |
| J7517 Mycophenolate mofetil, oral, 250 mg | J7524 (5 mg) | × 50 (1 old unit = 50 new units) |
| J7519 Injection, mycophenolate mofetil, 10 mg | J7526 (5 mg) | × 2 (1 old unit = 2 new units) |
| J7528 Mycophenolate mofetil, for suspension, oral, 100 mg | J7529 (5 mg) | × 20 (1 old unit = 20 new units) |
| J9181 Injection, etoposide, 10 mg | J9187 (1 mg) J9186: Injection, etoposide (avyxa), 1 mg | × 10 (1 old unit = 10 new units) |
| J9190 Injection, fluorouracil, 500 mg | J9192 (10 mg) J9191: Injection, fluorouracil (avyxa), 10 mg | × 50 (1 old unit = 50 new units) |
| J9352 Injection, trabectedin, 0.1 mg | J9362 (0.01 mg) C9312: Injection, trabectedin (apotex), not therapeutically equivalent to j9362, 0.01 mg | × 10 (1 old unit = 10 new units) |
| C9046 Cocaine hydrochloride nasal solution (goprelto), 1 mg | J0014 (1 mg) | Same units |
| C9310 Injection, leucovorin calcium (avyxa), 1 mg | J0644 (1 mg) | Same units |
| C9462 Injection, delafloxacin, 1 mg | J3268 (1 mg) | Same units |
| L8696 Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each | L8697 (each) | Same units |
| C8010 Percutaneous placement of permanent common carotid embolic protection device, including all system components and imaging guidance; bilateral | No Level II code for the same service in this update | – |
We matched each deleted code to the new code for the same drug or item by its CMS description. Check the drug's NDC and your payer's rules before you bill. A brand-specific code, such as the Avyxa versions, is only for that product.
Other changes billers should know
Ankle foot orthoses: L1971 now covers only an ankle foot orthosis that was customized to fit the patient by someone with expertise. The off-the-shelf version now uses the new code L1972.
New skin substitutes and wound products: A2046, A2047, A2048, A2049, A2050, Q4207, Q4223, Q4243. Most are billed per square centimeter as add-on codes to the application procedure.
New biosimilars: Q5172 (filgrastim-laha) and Q5173 (denosumab-adet). New autism test: G0685, an algorithm-based assessment that uses eye-gaze data.
See all 45 new codes for October 2026
| Code | Description |
|---|---|
| A2046 | Dermisphere hdrt, per square centimeter (add-on, list separately in addition to primary procedure) |
| A2047 | Lacertamatrix, per square centimeter (add-on, list separately in addition to primary procedure) |
| A2048 | Puraply mz, per milligram |
| A2049 | Theracor, per square centimeter (add-on, list separately in addition to primary procedure) |
| A2050 | Fibrillar collagen wound dressing, per milligram |
| A4228 | Supplies for maintenance of non-insulin, device-drug combination infusion catheter, per week |
| A6614 | Supplies and accessories for use with an external ocular negative pressure pump, any type, per month |
| A9613 | Piflufolastat f 18 (pylarify truvu), diagnostic, 1 millicurie |
| C9311 | Injection, eplontersen, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) |
| C9312 | Injection, trabectedin (apotex), not therapeutically equivalent to j9362, 0.01 mg |
| C9313 | Injection, pivekimab sunirine-pvzy, 0.01 mg |
| E0788 | Ambulatory infusion pump, specific device-drug combination, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
| E2403 | External ocular negative pressure pump, electric |
| G0685 | Algorithm-based assessment of likelihood of autism spectrum disorder (ASD), derived from validated analysis of eye-gaze data or other technology |
| J0014 | Cocaine hydrochloride nasal solution (goprelto), 1 mg |
| J0643 | Injection, leucovorin calcium, not otherwise specified, 1 mg |
| J0644 | Injection, leucovorin calcium (avyxa), 1 mg |
| J0871 | Injection, daptomycin (endo), not therapeutically equivalent to j0878, 1 mg |
| J1757 | Injection, tividenofusp alfa-eknm, 1 mg |
| J1818 | Injection, pegzilarginase-nbln, 0.05 mg |
| J1946 | Injection, furosemide (lasix onyu), 1 mg |
| J1947 | Injection, furosemide (furoscix), 1 mg |
| J1957 | Injection, levetiracetam, 5 mg |
| J1958 | Injection, levetiracetam in sodium chloride, 5 mg |
| J3268 | Injection, delafloxacin, 1 mg |
| J3406 | Injection, omidubicel-onlv, per therapeutic dose |
| J7524 | Mycophenolate mofetil, oral, 5 mg |
| J7526 | Injection, mycophenolate mofetil, 5 mg |
| J7529 | Mycophenolate mofetil, for suspension, oral, 5 mg |
| J7530 | Mycophenolate mofetil (myhibbin), oral suspension, 5 mg |
| J7531 | Prednisolone sodium phosphate, orally disintegrating tablet, 1 mg |
| J9066 | Injection, bendamustine hydrochloride (avyxa), 1 mg |
| J9186 | Injection, etoposide (avyxa), 1 mg |
| J9187 | Injection, etoposide, 1 mg |
| J9191 | Injection, fluorouracil (avyxa), 10 mg |
| J9192 | Injection, fluorouracil, 10 mg |
| J9362 | Injection, trabectedin, 0.01 mg |
| L1330 | Thoracic orthosis, sternal and/or sternocostal compression, may include anterior and/or posterior pads, panels, with or without frame, prefabricated, off the shelf |
| L1972 | Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, off-the shelf |
| L8697 | External accessory for use with implantable phrenic nerve stimulation device, replacement, each |
| Q4207 | Carbon life, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4223 | Dermabind sl optic, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4243 | Amchomatrix, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q5172 | Injection, filgrastim-laha (filkri), biosimilar, 1 microgram |
| Q5173 | Injection, denosumab-adet (ponlimsi), biosimilar, 1 mg |
See the 12 codes with a changed description
| Code | New description |
|---|---|
| A9595 | Piflufolastat f 18 (pylarify), diagnostic, 1 millicurie |
| C1982 | Catheter, pressure-generating, (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding) |
| C8004 | Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors |
| C9797 | Vascular embolization or occlusion procedure with use of a pressure-generating catheter (e.g., one-way valve or occlusion balloon, intermittently or temporarily occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction |
| C9812 | Echogenic and/or nerve stimulator-guided nerve block needles (e.g. sonoplex, sonoblock, sonotap, stimuplex), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the CAA, 2023) |
| J3300 | Injection, triamcinolone acetonide (triesence), preservative free, 1 mg |
| J9033 | Injection, bendamustine hydrochloride, not otherwise specified, 1 mg |
| L1971 | Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L8030 | Breast prosthesis, silicone or equal, without integral adhesive, any type |
| L8031 | Breast prosthesis, silicone or equal, with integral adhesive, any type |
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model, any type |
| S0169 | Calcitrol, oral, 0.25 microgram |
How HCPCS Level II Codes Are Organized
Every Level II code is one letter and four numbers. The letter tells you the type of item or service.
| Codes | What they cover | Active codes | Good to know |
|---|---|---|---|
| A codes | Ambulance and transport (A0), medical and surgical supplies (A4 to A8), radiopharmaceuticals and other items (A9) | 861 | – |
| B codes | Enteral and parenteral nutrition | 50 | – |
| C codes | Hospital outpatient codes | 382 | For hospital outpatient and ASC claims, not physician claims |
| E codes | Durable medical equipment (DME) | 666 | Billed to the DME MAC |
| G codes | Procedures and professional services | 1,276 | Includes G2211 and the annual wellness visit codes |
| H codes | Behavioral health and substance use services | 94 | Mostly used by Medicaid |
| J codes | Drugs given by injection or infusion, chemotherapy (J9) and some oral drugs | 1,112 | Billed in units of the dose in the description |
| K codes | Temporary codes for DME contractors | 142 | – |
| L codes | Orthotics and prosthetics | 935 | – |
| M codes | Medical services and quality reporting codes | 451 | – |
| P codes | Pathology and lab services | 58 | – |
| Q codes | Temporary codes, including skin substitutes (Q4) and biosimilars (Q5) | 589 | – |
| R codes | Transport of portable x-ray and EKG equipment | 3 | – |
| S codes | Private payer codes | 505 | Not valid for Medicare |
| T codes | State Medicaid codes | 114 | Not valid for Medicare |
| U codes | COVID-19 lab tests | 2 | – |
| V codes | Vision (V0 to V2), hearing and speech (V5) | 208 | – |
Codes that start with D are dental codes (CDT), owned by the American Dental Association, and are not in this tool.
How to Bill Drug Units Correctly
A J code is billed per the amount in its description. Divide the dose you gave by that amount to get the units. J1100 is dexamethasone, 1 mg, so a 10 mg dose is 10 units. If the dose falls between two unit amounts, follow the payer's rounding rule.
If the drug came from a single-dose vial, Medicare wants modifier JW on a separate line for any amount thrown away, or JZ on the line when none was thrown away. Too many units for one day can be denied as CO-151. A drug with no code of its own goes under J3490 or another unlisted code, with the drug name, NDC and dose in the claim notes.
Medicare Coverage Codes Explained
CMS gives every Level II code a coverage code. This tool shows it in plain English for each code.
| Code | What it means for Medicare | Active codes |
|---|---|---|
| C | Your Medicare contractor (MAC) decides if it is covered | 4,546 |
| D | Special coverage rules apply. Check the national or local coverage policy first | 1,882 |
| I | Not valid on Medicare claims. Medicare uses another code or does not pay. Other payers may accept it | 788 |
| M | Not covered by Medicare | 93 |
| S | Not covered by Medicare by law | 139 |
HCPCS vs CPT
HCPCS has two levels. Level I is CPT, the five-digit codes such as 99213 that the American Medical Association owns. Level II is the set in this tool. CMS maintains it, and it covers drugs, equipment, supplies, ambulance rides and services that CPT does not.
For CPT codes, use our RVU calculator and 2026 Medicare fee lookup, or read our guides to common CPT codes. Level II modifiers such as KX, RT and LT and the X modifiers are in the lookup above and in our modifier guides.
Source: the CMS HCPCS quarterly update, October 2026 alpha-numeric file. This tool is a lookup aid. Always check the payer's policy and the provider's documentation before you bill.
Frequently Asked Questions
Related tools: ICD-10 Code Lookup 2027 · RVU Calculator & 2026 Medicare Fee Lookup · Modifier Decision Tree · Underpayment Calculator · Denial Code Library
Written by Hassan Raza Awan
Founder — LegitMedBilling & IT Solutions
Hassan has 4+ years of hands-on U.S. medical billing experience — working claims, denials, credentialing, and payer follow-up for practices across the United States. Every guide he publishes is written from real remittances and payer behavior, not theory.
Billing a drug? Convert the NDC and work out the units and waste with the NDC units calculator, and check the daily limit in the MUE lookup. Check every code on a claim at once with our CMS-1500 claim checker.
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