Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots

Esophageal balloon distension studies are used to diagnose conditions of the esophagus and may be used to determine the source of certain types of pain, such as chest pain. The esophageal balloon study is often performed in conjunction with esophagogastroduodenoscopy procedures. Using CY 2024 claims data, CPT Code 91040 (Esophageal balloon distension study, diagnostic, with provocation when performed) had a proposed geometric mean cost of $2,007.29 in the CY 2026 OPPS/ASC proposed rule. For CY 2026, we proposed to continue to assign CPT code 91040 to APC 5723 (Level 3 Diagnostic Tests and Related Services) with a proposed payment rate of around $382.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Commenters requested that CMS reassign CPT code 91040 to APC 5724 (Level 4 Diagnostic Test and Related Services). Commenters stated that CPT code 91040 has the highest geometric mean cost of all codes assigned to APC 5723 and had a higher device offset percentage than other procedures in the same APC.

Response: We note that the updated geometric mean cost for CPT code 91040 is $2,001.92, and the geometric mean cost for APC 5723 is $384.16. While this is a significant difference, the CY 2024 claims data shows that only 2.6 percent (approximately 102 claims) of all the claims billed with CPT code 91040 (3,927 total claims frequency) were billed with only CPT code 91040 on the claim. We believe that, in addition to the higher costs of the packaged items, the costs from the other procedures that are performed with CPT code 91040 have driven up the geometric mean cost of CPT code 91040. Based on review of this procedure, other procedures in the same APC family, and the claims data, we believe that the clinical and resource characteristics of CPT code 91040 are sufficiently like other procedures assigned to APC 5723 and CPT code 91040 should continue to be assigned to APC 5723.

Therefore, for CY 2026 we are finalizing our proposal, without modification, to continue to assign CPT code 91040 to APC 5723 (Level 3 Diagnostic Tests and Related Services). Table 55 shows the finalized status indicator and APC assignment for the procedure codes. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website.

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CPT codes 0652T (Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)), 0653T (Esophagogastroduodenoscopy, flexible, transnasal; with biopsy, single or multiple), and 06534T (Esophagogastroduodenoscopy, flexible, transnasal; with insertion of intraluminal tube or catheter) describe the procedures for transnasal esophagogastroduodenoscopy. Using CY 2024 claims data, CPT codes 0652T, 0653T, and 0654T had geometric mean costs of $1,897.72, $1,107.54, $1,064.23,

respectively, in the CY 2026 OPPS/ASC proposed rule. For CY 2026, we believed CPT codes 0652T and 0653T were still appropriately assigned to APC 5302 (Level 2 Upper GI Procedures), which had a proposed payment rate of $1,975.59. We also believed that CPT code 0654T was still appropriately assigned to APC 5303 (Level 3 Upper GI Procedures), which had a proposed payment rate of $4,002.57. Therefore, we proposed to continue assigning CPT codes 0652T and 0653T to APC 5302 and CPT code 0654T to APC 5303.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT codes 0652T and 0653T to APC 1562 (New Technology--Level 25 ($3,501-$4,000)) and CPT code 0654T to APC 1563 (New Technology--Level 26 ($4,001-$4,500)). The commenter stated that since these are low volume procedures, reassigning these procedures to New Technology APCs would allow them to receive payment rates appropriate to their resource costs.

Response: We thank the commenter for their input. CPT codes 0652T, 0653T, and 0654T have updated GMCs of $1,744.52, $1,096.83, and $1,111.46 in the final rule data. After further clinical review, we continue to believe that CPT codes 0652T, 0653T, and 0654T are still appropriately assigned to APCs 5302 and 5303. Additionally, all three procedures have GMCs lower than the payment rate of their assigned APCs. Therefore, we are finalizing our proposal, without modification, to continue to assign CPT codes 0652T and 0653T to APC 5302 (Level 2 Upper GI Procedures) and CPT code 0654T to APC 5303 (Level 3 Upper GI Procedures). Table 56 shows the finalized status indicator and APC assignment for the procedure codes. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.074

Gastrointestinal Services 20. Gastric Electrophysiology Mapping With Simultaneously Validated Patient System Profiling (GEMS) Service, CPT Code 0868T (APC 5723)

Effective July 1, 2023, based on a New Technology application received by CMS for the GEMS service, CMS established HCPCS code C9787 (Gastric electrophysiology mapping with simultaneous patient symptom profiling) and assigned it to APC 5723 (Level 3 Diagnostic Tests and Related Services) based on a crosswalk to CPT code 0779T. Effective July 1, 2024, HCPCS code C9787 was deleted and replaced by CPT code 0868T (High-resolution gastric electrophysiology mapping with simultaneous patient symptom profiling, with interpretation and report). CMS assigned CPT code 0868T to APC 5723, the same APC to which its predecessor code, HCPCS code C9787, was assigned. For CY 2026, CMS proposed to continue to assign CPT code 0868T to APC 5723 with a proposed payment rate of $381.96 for CY 2026.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Several commenters requested that CMS not finalize the proposed APC assignment for CPT code 0868T. A commenter explained that the current payment amount is too low and has impacted the ability for the service to be provided to pediatric patients because Medicare payment rates impact the rates of commercial payors and state Medicaid programs. Some commenters drew distinctions between the CPT codes 0868T and 0779T. For example, a commenter stated that CPT code 0868T is fundamentally different from CPT code 0779T across every domain, including the technology, clinical protocol, staff and facility resources, and diagnostic outputs. Commenters requested that CMS assign CPT code 0868T to APC 5724 (Level 4 Diagnostic Tests and Related Services) or a new technology APC.

Response: We appreciate the commenters' input. First, we note that there is extremely low claims volume currently available for CPT code 0868T to justify a change in APC assignment based on existing claims data at this time. While the geometric mean cost of CPT code 0868T is approximately $3,000, this geometric mean cost is based on only 7 single frequency claims, which means that there is a high degree of variability in the limited claims data available. Additionally, based on our review of the technology and in consultation with our medical officers, we continue to believe that CPT codes 0868T and 0779T are comparable services in that they are both studies measuring gastrointestinal physiological activity. Additionally, there are other similar codes that describe gastrointestinal services assigned to APC 5723, such as CPT code 91020. Therefore, we believe that our proposal to assign CPT code 0868T is appropriate for CY 2026. We will continue to monitor the claims data and adjust the APC placement for CPT code 0868T based on the claims data in future rulemaking.

After consideration of the public comments, we are finalizing our proposal without modification to continue to assign CPT code 0868T to

APC 5723. The final CY 2026 payment rate for the code can be found in Addendum B to this final rule with comment period. We also refer readers to Addendum D1 to this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. 21. IB--Stim, CPT 64567 (APC 5301)

CPT code 64567 replaces placeholder code 64X11 (Percutaneous electrical nerve field stimulation, cranial nerves, without implantation) and is effective January 1, 2026. The code describes a neuromodulation therapy for the treatment of functional gastrointestinal disorders. CPT code 64567 replaces existing CPT code 0720T (Percutaneous electrical nerve field stimulation, cranial nerves, without implantation). For CY 2026, we proposed to assign CPT code 64567 to APC 5724 (Level 4 Diagnostic Tests and Related Services) and delete predecessor CPT code 0720T.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 64567 to APC 1515 (New Technology--Level 15 ($1301-1400)) with a payment rate of $1,350.50 for CY 2026. The commenter believes the procedure requires more resources than other services currently assigned to APC 5724, and that it is not clinically similar to those other procedures since it represents a therapeutic intervention rather than a diagnostic service. They further explained that no appropriate clinical APC exists for this procedure and note that it has very low Medicare utilization rates upon which to base a clinical APC assignment.

Response: After careful review of the service and the comment received as well as discussions with our medical officers, we are finalizing our proposals with modification. First, we are finalizing our proposal to delete CPT code 0720T as CPT code 64567 is replacing the predecessor code. However, we are not finalizing our proposal to assign CPT code 64567 to APC 5724, due to the clinical characteristics of the service. Specifically, we agree with the commenter that continued assignment to APC 5724 would not be appropriate because we believe CPT code 64567 represents a therapeutic service rather than a diagnostic procedure, based on the information available. We note that there were no claims for the service in CY 2024 for us to consider in our analysis. Therefore, due to the service's clinical characteristics, for CY 2026, we are assigning CPT code 64567 to APC 5301 (Level 1 Upper GI Procedures) as reflected in Table 57 with a payment rate of $926.63. We note that we will continue to monitor the claims data and update the payment rate in future rulemaking based on the available claims. The final CY 2026 payment rate for the code can be found in Addendum B to this final rule with comment period. We also refer readers to Addendum D1 to this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.075

Imaging Services 22. Computed Tomographic Colonography, CPT Code 74263 (APC 5523)

For CY 2024, we assigned CPT code 74263 (Computed tomographic (CT) colonography, screening, including image postprocessing) to status indicator “E1” indicating that the service was not covered and not payable by Medicare under OPPS. For CY 2025, we finalized assigning CPT code 74263 to APC 5523 (Level 3 Imaging without Contrast) using CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material) as a crosswalk code because of the coverage changes for colorectal cancer screening services. (See 89 FR 94287 through 94290 for a full discussion of the coverage changes for colorectal cancer screening services.)

For the CY 2026 OPPS/ASC proposed rule, we proposed to maintain the APC assignment for CPT code 74263 in APC 5523 (Level 3 Imaging without Contrast) with a proposed payment of around $245 and a status indicator of `S' (Procedure or Service, Not Discounted When Multiple; Paid under OPPS).

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 74263 to APC 5524 (Level 4 Imaging without Contrast) with a proposed payment of approximately $562. The commenter noted that CT colonography is a safe, minimally invasive exam that can save lives by detecting early disease. They stated that a lower reimbursement rate is likely to disproportionately affect underserved communities and exacerbate disparities in the early diagnosis of colorectal cancer.

Response: We thank the commenter for the input; however, we disagree with the commenters and believe that CPT code 74263 is appropriately assigned to APC 5523 (Level 3 Imaging without Contrast). Given that any claims data in CY 2024 would be from before the service was payable in the OPPS, it would be difficult to rely on the claims data to determine the APC assignment for this code. We reviewed the claims data and cost information for the crosswalk code and continue to believe that CPT code 74176 is an appropriate crosswalk code for CPT 74263. CPT code 74176 has a geometric mean cost around $164 based on 228,147 single frequency claims used for ratesetting under OPPS. After review and input from our CMS Medical Officers, we believe that CPT code 74263 is

appropriately assigned to APC 5523 (Level 3 Imaging without Contrast).

In summary, after consideration of the public comments we received, we are finalizing our proposal without modification, to assign CPT code 74263 to APC 5523 (Level 3 Imaging without Contrast). The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the status indicator definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website.

Refer to Table 58 for code descriptor, APC assignment and status indicator assignment CPT code 74263 for CY 2026. [GRAPHIC] [TIFF OMITTED] TR25NO25.076

The CPT Editorial Panel created 3 new Category I CPT codes 70471, 70472, and 70473 effective January 1, 2026 to replace the Category III CPT code 0042T. CPT code 0042T will be deleted effective January 1, 2026. The new final CPT codes (along with their placeholder codes) and the deleted Category III code are listed below with their long descriptors.

70471 (70XX1): Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing

70472 (70XX2): Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure)

70473 (70XX3): Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed without concurrent CT or CT angiography of the same anatomy

0042T: Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time

For CY 2026, we proposed to assign these codes to the following APCs and status indicators (SIs):

Assign CPT code 70471 to APC 5572 (Level 2 Imaging with Contrast), SI of `S' (Procedure or Service, Not Discounted When Multiple; Paid under OPPS);

Assign CPT code 70472 to SI of `N' (Items and Services Packaged into APC Rates; Paid under OPPS; payment is packaged into payment for other services); and

Assign CPT 70473 to APC 5571 (Level 1 Imaging with Contrast), SI of `S' (Procedure or Service, Not Discounted When Multiple; Paid under OPPS).

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS assign CPT code 70473 to APC 5572 (Level 2 Imaging with Contrast). The commenter indicated that the procedure described by CPT code 70473 is similar clinically and in resource use to the computed tomographic angiography procedure described by CPT code 70471. The commenter noted that the angiography procedure and the perfusion analysis are not always performed on the same date of service.

Response: After review of these new codes and input from our CMS Medical Officers, we believe that CPT code 70473 is more clinically similar to CPT code 70460 (Computed tomography, head or brain; with contrast material(s)),which has a geometric mean cost of around $173 and 2,659 single frequency claims in the CY 2024 claims data used for CY 2026 OPPS ratesetting. CPT code 70460 is currently assigned to APC 5571 (Level 1 Imaging with Contrast) and has a proposed payment of around $179. We remind hospitals that we review, on an annual basis, the APC assignments for all items and services paid under the OPPS.

In summary, after consideration of the public comments we received, we are finalizing our proposal without modification. The final CY 2026 payment rates for these codes can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website.

Refer to Table 59 for code descriptors, APC assignments and status indicator assignments for CPT codes 70471, 70472, and 70473 for CY 2026.

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For CY 2026, we proposed to continue to assign CPT code 93880 (Duplex scan of extracranial arteries; complete bilateral study) to APC 5523 (Level 3 Imaging without Contrast) and a status indicator of `S' with a proposed payment of $245.72.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 93880 to APC 5524 (Level 4 Imaging without Contrast) with a proposed payment of $562.07. The commenter stated that CPT code 93880 should be reassigned due to its clinical and resource similarity to CPT code 93306 (Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography), which is assigned to APC 5524.

Response: We thank the commenter for their input; however, we disagree with their recommendation. We review, on an annual basis, the APC assignments for all services and items paid under the OPPS based on our analysis of the latest claims data. For the CY 2026 OPPS update, based on CY 2024 claims data, our analysis for this final rule with comment period supports the continued assignment of CPT code 93880 to APC 5523 (Level 3 Imaging without Contrast) based on its clinical and resource homogeneity to the procedures and services in APC 5523. Specifically, our claims data show a GMC of approximately $230 based on 410,021 single frequency claims for CPT code 93880, which is consistent with the GMC of approximately $246 for APC 5523, rather than the GMC of approximately $563 for APC 5524 (Level 4 Imaging without Contrast). We believe the resource requirements for CPT code 93880 are more similar to procedures found in APC 5523 (Level 3 Imaging without Contrast) rather than APC 5524 (APC Level 4 Imaging without Contrast).

In summary, after consideration of the public comment, we are finalizing our proposal without modification to assign CPT code 93880 to APC 5523 (Level 3 Imaging without Contrast) for CY 2026. The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. 25. Duplex Scan of Hemodialysis Fistula, CPT Code 0876T

The AMA CPT Editorial Panel established CPT code 0876T (Duplex scan of hemodialysis fistula, computer-aided, limited (volume flow, diameter, and depth, including only body of fistula)) effective July 1, 2024. We assigned CPT code 0876T to status indicator `E1' for July 1, 2024, based on our belief that the implantable marker used with this procedure did not have FDA approval.

For CY 2026, we proposed to continue to assign CPT code 0876T to E1 (Not covered by any Medicare outpatient benefit category; Statutorily excluded by Medicare, Not reasonable and necessary; Not paid by Medicare when submitted on outpatient claims) because we have not been notified by interested parties regarding an updated FDA status.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS assign CPT code 0876T to an APC for payment under the OPPS. The commenter noted that the vast number of end-stage renal disease admissions are related to complications with patients' vascular access and the cost savings of salvaging fistulas versus replacing them.

Response: We are unable to determine if all parts of this service have been approved by the FDA and therefore are maintaining the status indicator assignment of `E1'. We look forward to hearing from the manufacturer when FDA approval has been obtained.

In summary, after consideration of the public comment that we received, we are finalizing the status indicator assignment for 0876T without modification. The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. 26. Non-Cardiac Contrast Enhanced Ultrasound (CEUS), CPT Codes 76978 and 76979 (APC 5572)

CPT codes 76978 and 76979 describe non-cardiac contrast enhanced ultrasounds. Their code descriptors are as follows:

76978: Ultrasound, targeted dynamic microbubble sonographic

contrast characterization (non-cardiac); initial lesion.

76979: Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection (List separately in addition to code for primary procedure).

For CY 2026, we proposed to assign CPT codes 76978 and 76979 to APC 5571 (Level 1 Imaging with Contrast). CPT code 76978 had a geometric mean cost of around $287 based on 710 single frequency claims and CPT code 76979 was packaged with a primary procedure.

Comment: Several commenters requested reassignment of CPT codes 76978 and 76969 from their current assignment in APC 5571 (Level 1 Imaging with Contrast) to APC 5572 (Level 2 Imaging with Contrast). CPT code 76978 describes ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac) for the initial lesion, while CPT code 76979 describes each additional lesion with a separate injection and is packaged with the primary procedure code per OPPS policy. The commenters stated that the current APC assignment does not adequately reflect the resource costs associated with these specialized contrast-enhanced ultrasound procedures.

Response: We agree with the commenters' request for APC reassignment. After reviewing the clinical characteristics and resource costs associated with CPT codes 76978, we are reassigning 76978 from APC 5571 (Level 1 Imaging with Contrast) to APC 5572 (Level 2 Imaging with Contrast) for CY 2026 as reflected in Table 60. This reassignment better reflects the complexity and resource intensity of non-cardiac contrast enhanced ultrasound procedures. CPT code 76978 will be assigned status indicator “S” (separately payable) under APC 5572, while CPT code 76979 will maintain status indicator “N” (packaged) and will continue to be packaged with the primary procedure code 76978 under the new APC assignment. This change recognizes the specialized nature of contrast-enhanced ultrasound technology and ensures appropriate payment for these services. The reassignment will be effective beginning January 1, 2026. [GRAPHIC] [TIFF OMITTED] TR25NO25.078

Effective July 1, 2020, the AMA CPT Editorial Panel established CPT code 0600T (Ablation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed, percutaneous) which describes a technique in which an electrical field is applied to cells in order to increase the permeability of the cell membranes through the formation of nanoscale defects in the lipid bilayer. The result is creation of nanopores in the cell membrane and disruption of intra-cellular homeostasis, ultimately causing cell death. The procedure received CPT code 0600T from the AMA in July 2020, and we assigned CPT code 0600T to APC 5362 (Level 2 Laparoscopy and Related Services) in the CY 2021 OPPS/ASC final rule with comment period. For the CY 2026 OPPS/ASC proposed rule, CPT code 0600T had a geometric mean cost of around $13,068 and we proposed to continue to assign the procedure to APC 5362, which has a proposed payment rate of around $10,967 and status indicator J1 (Hospital part B services paid through a comprehensive APC). For the CY 2026 OPPS/ASC proposed rule, we proposed CPT code 0600T to be a device intensive procedure with a proposed device offset percentage of 57.02 percent based on claims data for CPT code 0600T.

Effective July 1, 2025, the AMC CPT Editorial Panel established placeholder CPT code 4001X (Ablation, irreversible electroporation, liver, 1 or more tumors, including imaging guidance, percutaneous); and placeholder CPT code 5XX11 (Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous). CPT code 47384 is the final code for 4001X and CPT code 55877 is the final code for 5XX11. For the CY 2026 OPPS/ASC proposed rule, we proposed to assign CPT code 47384 and CPT code 55877 to APC 5362 and status indicator J1. For the CY 2026 OPPS/ASC proposed rule, we proposed CPT code 47384 and CPT code 55877 to be device intensive procedures with a proposed device offset percentage of 31 percent which is the default for new device intensive procedures that lack claims data, or lack claims data from a predecessor code or a clinically related or similar code.

We note that at the August 25, 2025, HOP Panel Meeting, a presentation was made requesting: (1) reassignment to APC 5377 (Level 7 Urology and Related Services) for CPT code 55877; (2) reassignment to APC 1575 (New Technology--Level 38) for CPT codes 47384 and 0600T; and (3) the use of the claims data for CPT code 0600T to determine the device offset percentage for CPT codes 47384 and 55877. Based

on the information presented at the meeting, the Panel recommended that CMS use the claims data for CPT code 0600T to determine the device offset percentage for CPT code 47384 and CPT code 55877. The Panel made no recommendation on the APC assignments for CPT codes 0600T, 47384 and 55877.

We received public comments on this topic. The following is a summary of the comments we received and our responses.

Comment: A few commenters requested reassignment from APC 5362 to APC 5377 (Level 7 Urology and Related Services) for CPT code 55877 and reassignment from APC 5362 to APC 1575 (New Technology--Level 38) for CPT codes 47384 and 0600T. One of the commenters additionally requested device-intensive status for CPT codes 0600T, 47384 and 55877. We refer readers to sections IV.B. and XIII.C. of this final rule with comment period for our response those requests.

The commenters stated that all three procedures need to be reassigned because the CY 2024 claims data for CPT code 0600T shows a geometric mean cost of $13,068, which is higher than the proposed APC 5362 geometric mean cost of $11,137. For which specific APCs the procedures should be assigned to, the commenters stated that it is appropriate to assign CPT code 55877 to APC 5377 (Level 7 Urology and Related Services) based on resource and clinical coherence. The commenters stated that the costs associated with CPT code 0600T are more akin to the geometric mean of APC 5377 and the clinical range of services included in APC 5377 encompass ablation procedures, including CPT 55882, that are used in treating the same patient diagnoses and population. For CPT codes 0600T and 47384, commenters stated that there is no clinically appropriate APC that fits these procedures from both a clinical and resource perspective, so they proposed to reassign them to APC 1575 based on geometric mean cost. Alternatively, the commenter suggested, if CMS believes that all three procedures should be assigned to the same APC, the alternative APC assignment for placeholder code 55877 could be APC 1575.

Response: We thank the commenters for their recommendations. After consideration of the public comments we received and discussion and input from our Medical Officers, we are finalizing our proposal without modification for the APC assignments for CPT codes 0600T, 47384 and 55877. We believe the current claim data for 0600T indicates that APC 5362 is an appropriate assignment for these services. We note that we review the APC assignments for all items and services paid under the OPPS on an annual basis. We will reevaluate the APC assignments for CPT codes 0600T, 47384 and 55877 in the next rulemaking cycle.

Table 61 shows the finalized status indicator and APC assignment for these procedure codes. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.079

Certain clinical diagnostic laboratory tests that are listed on the Clinical Laboratory Fee Schedule (CLFS) are packaged in the OPPS as integral, ancillary, supportive, dependent, or adjunctive to the primary service or services provided in the hospital outpatient setting during the same outpatient stay. Specifically, we conditionally package laboratory tests and only pay separately for laboratory tests when (1) they are the only services provided to a beneficiary on a claim; (2) they are molecular pathology tests; (3) they are advanced diagnostic laboratory tests (ADLTs) that provide an analysis of multiple biomarkers of DNA, RNA, or proteins combined with a unique algorithm to yield a single patient-specific result; or (4) the laboratory tests are considered preventive services. When laboratory tests are not packaged under the OPPS and are listed on the CLFS, they are paid at the CLFS payment rates, outside the OPPS, under Medicare Part B. 28. Diagnostic Biomarker Tests for Alzheimer's Disease, CPT Codes 0551U and 0568U

Recently, the AMA CPT Editorial Panel created two new CPT codes to describe diagnostic biomarker tests for Alzheimer's disease. CPT code 0551U became effective April 1, 2025, and CPT code 0568U became effective October 1, 2025. The CPT codes and their descriptors are as follows:

0551U (Tau, phosphorylated, pTau217, by single-molecule array (ultrasensitive digital protein detection), using plasma); and

0568U (Neurology (dementia), beta amyloid (A[beta]40, A[beta]42, A[beta]42/40 ratio), tau-protein phosphorylated at residue (eg, pTau217), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), by ultra-high sensitivity molecule array detection, plasma, algorithm reported as positive, intermediate, or negative for Alzheimer pathology).

In the CY 2026 OPPS/ASC proposed rule, we proposed to assign CPT codes

0551U and 0568U status indicator “Q4” under OPPS.

Comment: We received one comment in support of our proposal. A commenter commended CMS's commitment to developing the basis of payment for these new clinical diagnostic laboratory tests with the addition of CPT codes 0551U and 0568U.

Response: We thank the commenter for their support. However, on October 1, 2025, the AMA CPT Editorial Panel deleted CPT code 0551U effective January 1, 2026. Therefore, for CY 2026, we will delete this code from this final rule with comment period and the January 2026 Update. However, we are finalizing our proposal to assign status indicator “Q4” to CPT code 0568U for CY 2026.

We refer readers to Addendum D1 of this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addendum D1 is available via the internet on the CMS website. 29. PreciseBreast Test, CPT Code 0220U

AMA CPT Editorial Panel created CPT code 0220U on October 1, 2020 to describe a clinical diagnostic laboratory test that utilizes an Al- digital risk assessment methodology to measure protein-based biomarkers that are digitized to recapitulate the location, morphology and biological grade of a patient's invasive (ductal) breast cancer.

In the CY 2026 OPPS/ASC proposed rule, we proposed to continue assigning CPT code 0220U to status indicator “Q4” under OPPS.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS update its guidance on the laboratory date of service (DOS) policy for protein-based multianalyte algorithmic tests for cancer indications. Under the DOS regulations at Sec. 414.510(b)(5), a clinical diagnostic laboratory test on a specimen collected during a hospital outpatient encounter can be billed by the performing laboratory if the test involves DNA, RNA or protein biomarkers or is classified as an Advanced Diagnostic Laboratory Test (ADLT). PreciseBreast[supreg] test (0220U) \1\ is a cancer-related protein-based multi-analyte algorithmic test, however, because it is assigned a Proprietary Laboratory Analyses” (PLA) code by AMA CPT Editorial Panel, it does not meet the exclusion from the DOS policy under CMS's current interpretation. According to the commenter, they cannot bill Medicare for their PreciseBreast[supreg] test even though it is performed in their laboratory outside of the hospital. This has significantly limited access to the targeted clinical diagnostic information that the test provides to breast cancer patients.

The commenter requested that CMS update the laboratory DOS policy at Sec. 414.510(b)(5) to clarify that PreciseBreast[supreg], as a cancer-related protein-based MAAA, can be billed by the performing lab with a DOS of the date of test performance. PreciseBreast[supreg] should be added to CMS's list of “Laboratory Tests Subject to Exceptions to Laboratory DOS Policy Defined at Sec. 414.510(b)(5))”, reassigned to Status Indicator “A”, and excluded from packaging in the outpatient setting.

Response: We thank the commenter for their input but note that the comment related to the Date of Service (DOS) policy is out of scope for the purposes of this OPPS/ASC final rule with comment period as there was no proposal to modify the DOS regulations in the CY 2026 OPPS/ASC proposed rule.

We also do not believe that PreciseBreast[supreg] test qualifies as an exception to the OPPS laboratory packaging policy based on criteria discussed in the Laboratory Related Services section.

Based on that information, we continue to believe that the assignment of status indicator “Q4” to CPT code 0220U is still appropriate and are finalizing without modification, our proposal to assign CPT code 0220U to status indicator “Q4” for CY 2026. 30. Screening DNA/RNA Test for Hepatitis C Virus, HCPCS Code G0567

In the April 2025 quarterly update, effective June 27, 2024, CMS created a new HCPCS code, G0567, to describe a new screening DNA/RNA test for Hepatitis C Virus. We assigned this code to status indicator “A” under OPPS indicating that this code would be paid separately under clinical laboratory fee schedule (CLFS), similar to other preventive screening tests that are excluded from the OPPS packaging policy for the laboratory tests.

In the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign HCPCS code G0567 to status indicator “A”.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested confirmation on the assignment of status indicator “A” where a commenter stated that such an assignment would be fully consistent with CMS precedent for other “screening” G- codes, such as G0472 (Hepatitis c antibody), G0475 (HIV antigen/ antibody), G0476 (HPV co-testing), G0499 (Hep B screening)).

Response: We thank the commenter for their feedback and believe that the assignment of status indicator “A” continues to be appropriate for CY 2026. Therefore, we are finalizing our proposal, without modification to assign HCPCS code G0567 to status indicator “A” for CY 2026. We refer readers to OPPS Addendum D1 to this final rule with comment period for the status indicator definitions for all codes reported under the OPPS. 31. Laparoscopic Hernia Repair and Appendectomy, Procedures, CPT Codes 49650, 49651, and 44970 (APC 5342)

CPT codes 49650 (Laparoscopy, surgical; repair initial inguinal hernia) and 49651 (Laparoscopy, surgical; repair recurrent inguinal hernia) describe laparoscopic hernia repair procedures. CPT code 44970 (Laparoscopy, surgical, appendectomy) describes the procedure for laparoscopic appendectomy. Using CY 2024 claims data, CPT codes 49650, 49651, and 44970 had geometric mean costs of $7,050.22, $7,173.25, $6,777.47, respectively, in the CY 2026 OPPS/ASC proposed rule. For CY 2026, we believed these were still appropriately assigned to APC 5361 (Level 1 Laparoscopy and Related Services), which had a proposed payment rate of $6,228.97. Therefore, we proposed to continue assigning CPT codes 49651, 49651, and 44970 to APC 5361.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: The HOP Panel recommended that we reassign CPT codes 49650, 49651, and 44970 to APC 5342 (Level 2 Abdominal/Peritoneal/ Biliary and Related Procedures) based on clinical and resource similarity to procedure in that APC. A commenter disagreed with the HOP Panel's recommendation and instead requested that CMS finalize our proposal without modification due to potential disruption to the payment rate for APC 5361 if we were to remove the three procedures.

Response: We thank the commenter for their input. CPT codes 49650, 49651, and 44970 have updated GMCs of $6,902.69, $7,040.05, and $6,638.55 in the final rule data. While these are closer to the payment rate for APC 5342, after clinical review of these procedures, we did not find APC 5342 to be the clinically appropriate APC family for CPT codes 49650, 49651, and 44970. We

continue to believe that these procedures belong in the Laparoscopy and Related Procedures family and are appropriately paid based on the payment rate for APC 5361.

After consideration of the public comment we received, we are finalizing our proposal without modification to continue to assign CPT codes 49650, 49651, and 44970 to APC 5361 (Level 1 Laparoscopy and Related Services).

Table 62 shows the finalized status indicator and APC assignment for the procedure codes. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.080

CPT codes 0559T (Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure) and 0561T (Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide) were established in 2019 to describe medical 3D printing services. For the CY 2026 OPPS/ASC proposed rule, CPT code 0559T had a geometric mean of approximately $183 based on 12 single frequency claims and 16 total frequency claims, and CPT code 0561T had a geometric mean cost of approximately $255 based on 8 single frequency claims and 84 total frequency claims. For CY 2026, we proposed to continue to assign CPT codes 0559T and 0561T to APC 5733 (Level 3 Minor Procedures) and status indicator “Q1.”

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS assign CPT codes 0559T and 0561T to APC 5735 (Level 5 Minor Procedures) because the resources and supplies needed to provide these services are greater than the proposed payment rates. The commenter explained that the low utilization for both codes caused a lack of reliable claims data for ratesetting and urged us to assign the codes to a clinical APC with a higher payment rate to ensure patient access. Per the commenter, the 3D-printed models cost close to $3,000 per patient.

Response: Based on the geometric mean cost of both codes, we agree with the commenter that the proposed payment rate is not appropriate for CPT codes 0559T and 0561T, as the payment rate is significantly lower than the geometric mean cost of the codes. Based on the claims data available, we believe an assignment to APC 5734, a higher payment level within the same clinical APC, would align more closely with the geometric mean costs for both codes.

After consideration of the public comment we received, we are finalizing our proposal with modification to assign CPT codes 0559T and 0561T to APC 5734 and status indicator “Q1” as reflected in Table 63. As we do every year, we will re-evaluate the APC assignments for these codes in the next rulemaking cycle. [GRAPHIC] [TIFF OMITTED] TR25NO25.081

Neuro and Nerve Related Procedures 33. Continuous EEG Monitoring, CPT Codes 0956T, 0960T (APC 5117)

Continuous EEG monitoring involves an implantable device. The device is an electroencephalographic (EEG) recording and transmitting device implanted under the scalp. It is a prescription device indicated to acquire, transmit, and store EEGs continuously from patients between 18-75 years of age with drug-resistant epilepsy who are intolerant or not indicated for more conservative monitoring tools. The device is intended to aid a physician's remote assessment and monitoring of the indicated patient's condition.

The medical use of the data acquired by the continuous EEG monitoring system is to be performed under the direction and interpretation of a licensed medical professional. The device does not provide any diagnostic conclusions about the patient's condition.

The AMA CPT Editorial Board created five new Category III CPT codes to describe various procedures associated with a sub-scalp bilateral continuous

EEG monitoring system to assist in identifying seizure activity for patients with drug resistant epilepsy (DRE). Specifically, effective July 1, 2025, the three new CPT codes are:

0956T--Partial craniectomy, channel creation, and tunneling of electrode for sub-scalp implantation of an electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance

0957T--Revision of sub-scalp implanted electrode array, receiver, and telemetry unit for electrode, when required, including imaging guidance

0958T--Removal of sub-scalp implanted electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance

0959T--Removal or replacement of magnet from coil assembly that is connected to continuous bilateral electroencephalography monitoring system, including imaging guidance

0960T--Replacement of sub-scalp implanted electrode array, receiver, and telemetry unit with tunneling of electrode for continuous bilateral electroencephalography monitoring system, including imaging guidance

In the CY 2026 OPPS/ASC proposed rule, we proposed to assign CPT codes 0956T and 0960T to status indicator “S” and APC 1577 (New Technology--Level 40 ($20,001-$25,000)) with a proposed payment rate of $22,500.50. CPT code 0957T was assigned to status indicator “J1” and APC 5112 (Level 2 Musculoskeletal Procedures) with a proposed payment rate of $1,659.95. CPT code 0958T was assigned to status indicator “J1”, APC 5113 (Level 3 Musculoskeletal Procedures) with a proposed payment rate of $3,377.20. CPT code 0959T was assigned to status indicator “Q2” APC 5072 (Level 2 Excision/Biopsy/Incision and Drainage) with a proposed payment rate of $1,692.22.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Several commenters requested that CMS reexamine and revise the reimbursement rates for CPT codes 0956T and 0960T because, according to the commenters, outpatient reimbursement for services associated with sub-scalp EEG monitoring is substantially below the actual resources required to deliver them.

A few commenters urged CMS to move CPT codes 0956T and 0960T to a higher-paying New Technology APC.

A commenter recommended that CMS assign both CPT codes to APC 1579 (New Technology--Level 42 ($30,001-$40,000)). Their analysis indicated that a similar procedure is the implantation of a cochlear implant. In evaluating the CY 2026 OPPS claims data, the procedure costs of implanting a cochlear implant (CPT code 69930) are $8,461. The commenter stated that the cost of the device is $25,000, so total estimated hospital costs of the procedure are $33,461. The commenter requested that CMS reassign CPT codes 0956T and 0960T to APC 1579.

Another commenter estimated that the total procedure costs for 0956T and 0960T exceed $35,000. Device costs are approximately $25,000. Surgical and facility costs for outpatient implantation procedures add approximately $10,000. The commenter stated that with the current proposed reimbursement falling $12,500 short of actual costs, a hospital would be unlikely to offer this service, and patients would not be able to access this service.

Response: Based on clinical similarity and resource homogeneity of the procedures described by CPT codes 0956T and 0960T to existing procedures assigned to the Level 7 Musculoskeletal Procedures APC, and based on input from our medical advisors, we are assigning CPT codes 0956T and 0960 to status indicator “J1” and APC 5117 (Level 7 Musculoskeletal Procedures) for CY 2026 as reflected in Table 64.

The final payment rates for the codes can be found in Addendum B to this final rule with comment period. In addition, we refer to Addendum D1 to this final rule with comment period for the status indicator (SI) meanings for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.082

Transcutaneous Magnetic Peripheral Nerve Stimulation is intended to stimulate peripheral nerves for relief of chronic intractable pain, post[hyphen]traumatic pain, post[hyphen]surgical pain and/or for relief of chronic painful diabetic peripheral neuropathy in the lower extremities for patients 18 and older. CPT code 0766T (Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction

localization), when performed; first nerve) became effective January 1, 2023. For CY 2025, CPT code 0766T was reassigned to APC 5722 (Level 2 Diagnostic Tests and Related Services) with the status indicator “S” (Significant Procedures, Not Discounted when Multiple. Paid under OPPS; separate APC payment). There are no claims available for CPT code 0766T in CY 2024. For CY 2026, we proposed to continue assigning CPT code 0766T to APC 5722.

CPT code 0767T (Transcutaneous magnetic stimulation by focused low- frequency electromagnetic pulse, peripheral nerve, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (list separately in addition to code for primary procedure)) became effective January 1, 2023 and assigned status indicator “N” (packaged). CPT code 0767T is an add-on code and we proposed to continue assignment of status indicator “N” for this code for CY 2026.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Commenters requested CPT code 0766T be reassigned to APC 5724 (Level 4 Diagnostic Tests and Related Services), claiming that CPT code 0766T is not clinically similar and does not use comparable resources to other services in APC 5722. The commenters requested that CMS follows the 2025 HOP Panel recommendations to reassign 0766T to APC 5724 (Level 4 Diagnostic Tests and Related Services) and reassign the 0767T status indicator to “S” (Significant Procedures, Not Discounted when Multiple. Paid under OPPS; separate APC payment).

Response: We disagree that CPT code 0766T is comparable, clinically and in resource costs, to the services assigned to APC 5724. We continue to believe CPT code 0766T is more comparable, clinically and from a resource cost perspective, to CPT code 90867 (Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; initial, including cortical mapping, motor threshold determination, delivery and management), and CPT code 90868 (Therapeutic repetitive transcranial magnetic stimulation (tms) treatment; subsequent delivery and management, per session), which are assigned to APC 5722 (Level 2 Diagnostic Tests and Related Services), because these services share similar magnetic stimulation and nerve localization processes.

We note that CPT code 0767T is an add-on code. Add-on codes are always performed in addition to the primary service or procedure and not reported as a stand-alone code. As specified under regulation 42 CFR 419.2(b)(18), add-on codes are generally packaged under the OPPS, and payment for the codes are bundled with the primary codes. Consequently, CPT code 0767T is not paid separately under the OPPS and its payment is packaged into payment for the primary code.

After consideration of the public comments we received, we are finalizing our proposed APC assignment and status indicators for CPT codes 0766T and 0767T without modification. Refer to Table 65 for the final OPPS APC and status indicator assignment for CPT codes 0766T and 0767T for CY 2026. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.083

For CY 2026, the AMA CPT Editorial Board created a new Category I CPT code 64728 (Placeholder code 647XX) to describe carpal tunnel release procedures using ultrasound guidance. In the CY 2026 OPPS/ASC proposed rule, we proposed to assign CPT code 647XX to APC 5431 (Level 1 Nerve Procedures) with status indicator “J1” and a proposed payment rate of $1,999.82.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter believes overall hospital resources for this service can be approximated using other similar procedures--for example, endoscopic carpal tunnel release (CPT code 29848 (Endoscopy, wrist, surgical, with release of transverse ligament)) and

open carpal tunnel release (CPT code 64721 (Neuroplasty and/or transposition; median nerve at carpal tunnel))--and adding the single- use device cost of $1,099, plus the $140 cost of intraprocedure ultrasound to those other costs. Using the geometric mean costs for these services and adding the single-use device and intraprocedure ultrasound costs results in an estimated cost of between $3,048 and $3,454 for the new 647XX procedure.

Based on this information, the commenter suggested that CMS re- assign CPT code 64728 to APC 1524 (New Technology--Level 24 ($3001- $3500) with status indicator “S” and a proposed payment rate of $3,250.50 or alternatively re-assign it to APC 5432 (Level 2 Nerve Procedures) with status indicator “J1” and a proposed payment rate of $6,667.00 or to APC 5113 (Level 3 Musculoskeletal Procedures) with status indictor “J1” with a proposed payment rate of $3,377.20.

Response: Based on the estimated resource costs and clinical similarity of CPT code 64728 to other surgical procedures assigned to APC 5431, we continue to believe that the assignment of CPT code 64728 to APC 5431 is appropriate. Therefore, we are finalizing without modification our proposal to assign CPT code 64728 to APC 5431 for CY 2026.

We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. Neurostimulators 36. Creation of a Level 6 Neurostimulator APC

In prior rulemaking, some interested parties have requested that we create a Level 6 Neurostimulator and Related Procedures APC, due to their concerns around clinical and resource cost similarity in the Level 5 Neurostimulator and Related Procedures APC. We most recently responded to this request in the CY 2025 OPPS/ASC final rule with comment period (89 FR 94064). We noted that we believed that the current 5 level APC structure for the Neurostimulator and Related Procedures series provided for an appropriate distribution of clinical and cost similarity at the different APC levels. As discussed in the CY 2021 OPPS/ASC final rule with comment period, we reiterate that the OPPS is a prospective payment system. We group procedures with similar clinical characteristics and resource costs into APCs and establish a payment rate that reflects the geometric mean of all services in the group even though the cost of any individual service within the APC may be higher or lower than the APC's geometric mean. As a result, in the OPPS, any individual procedure may potentially be paid more or less than the cost of the services because the payment rate is based on the geometric mean of the entire group of services in the APC. However, the impact of these payment differences should be mitigated when distributed across a large number of APCs (85 FR 85968).

While we continued to believe that a five-level structure for the Neurostimulator and Related Procedures APC series remains appropriate, we solicited comment from interested parties on the need for a Level 6 APC, given the clinical and estimated cost characteristics of the services currently assigned to the Level 5 APC and New Technology APC 1580 (New Technology--Level 43 ($40,001-$50,000)).

In summary, for the CY 2026 OPPS, we proposed to maintain the current 5 level structure for the Neurostimulator and Related Procedure APC series. We also solicited comments on potentially creating an additional Level 6 APC in the series.

See Table 66 for proposed CY 2026 SI and APC assignments for specific HCPCS codes in the series and Table 67 for the proposed CY 2026 Neurostimulator and Related Procedures APCs. [GRAPHIC] [TIFF OMITTED] TR25NO25.084

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We received public comments on the proposal to maintain the 5 level APC structure. The following is a summary of the comments we received and our responses.

Comment: Some commenters supported the proposal to continue assigning CPT code 0266T/64XX5 (Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed)) to New Technology APC 1580. Commenters also supported maintaining assignment of CPT code 33276 (Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial analysis with diagnostic mode activation, when performed) to New Technology APC 1580.

Other commenters noted that CPT code 64568 (Open implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator) which has similar characteristics to 33276 and 0266T/ 64XX5 should similarly be placed in New Technology APC 1580, based on its geometric mean cost and that continuing to assign CPT code 64568 to the Level 5 Neurostimulator and Related Procedures APC would be an inconsistent treatment of the procedure code, relative to the others. Finally, a commenter suggested that a combined C-code be created to pair 64568 with C1827 (Generator, neurostimulator (implantable), non- rechargeable, with implantable stimulation lead and external paired stimulation controller).

At the August 2025 HOP Panel meeting, the HOP panel made a recommendation to consider placement of CPT code 64568 to New Technology APC 1580.

Response: We appreciate the commenters' support for the proposed assignments of HCPCS codes 33276 and 0266T/64XX5 to New Technology APC 1580.

We agree that it is appropriate to assign CPT code 64568 to New Technology APC 1580 based on its geometric mean cost of $46,926.67 and apply a similar temporary New Technology APC assignment, as we have for the other neurostimulator procedure codes assigned to that APC. We will continue to monitor the claims data for the code as additional claims become available. Finally, we do not believe the creation of a C-code pairing CPT code 64568 and device code C1827 is necessary or appropriate, given a final placement for the primary procedure code to New Technology APC 1580 in this final rule with comment period.

Comment: Many commenters requested the creation of a Level 6 Neurostimulator and Related Procedures APC, with some requesting that specific codes or codes with similar costs be included in that Level 6 APC. We note that at the August 2025 HOP Panel meeting, the HOP panel made a recommendation to create a Level 6 Neurostimulator APC.

Commenters stated that while they appreciated the assignment of specific codes to New Technology APCs and that those assignments represent a viable short term solution, a Level 6 APC represents a more long term solution to commenter concerns, including those around procedure payment relative to costs. A commenter also noted that some of the factors supporting the creation of the Level 7 Musculoskeletal Procedures APC would also apply to this series, such as the bimodal distribution of cost and potential placement of procedures being removed from the IPO list. A commenter also noted that although a Level 6 Neurostimulator and Related Procedures APC would have relatively low claims volume, that there are already other comparable APCs with low volume in the Intraocular Procedures APC series.

A few commenters supported maintaining the current 5 level structure of the APC series. One of the commenters requested that CMS not make any changes to the APC series structure or any of its assignments until a more comprehensive review of the current APC family could be performed.

Response: We appreciate the thoughtful responses commenters have provided with regard to the Neurostimulator and Related Procedures APC series and our request for comments.

At this time, we believe the 5-level APC structure for the APC series remains appropriate and individual temporary New Technology APC assignments with respect to the high cost procedures in this evolving area resolve some of the concerns around procedure payment relative to cost. We will continue to monitor the claims data for these procedures as more information around their volume and estimated costs become available.

After consideration of public comments, we are assigning CPT code 64568 to New Technology APC 1580 and maintaining the 5-level APC structure for the Neurostimulator and

Related Procedures APC series in the CY 2026 OPPS.

See Table 68 for final CY 2026 SI and APC assignments for specific HCPCS codes in the series and Table 69 for the final CY 2026 Neurostimulator and Related Procedures APCs. BILLING CODE 4120-01-P [GRAPHIC] [TIFF OMITTED] TR25NO25.086

[GRAPHIC] [TIFF OMITTED] TR25NO25.087

BILLING CODE 4120-01-C 37. Neurostimulator and Related Procedures (APCs 5461 Through 5465)

In the CY 2021 OPPS/ASC final rule with comment period, we finalized a five-level APC structure for the Neurostimulator and Related Procedures series (85 FR 85968 through 85970). For a detailed discussion of the history of neurostimulators policy, we refer readers to the CY 2015, CY 2020, CY 2021, CY 2023, CY 2024, and CY 2025 OPPS/ ASC final rules with comment period (79 FR 66807 through 66808; 84 FR 61162 through 6116, 85 FR 85968 through 85970; 87 FR 71869; 88 FR 81645 through 81658; 89 FR 94062 through 96045). CPT Codes 61885 and 64590

Effective January 1, 1982, The AMA CPT Editorial Board created Category I CPT code 61885 (Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array) and CPT code 64590 (Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver).

Based on the estimated resource costs and clinical similarity of HCPCS code 61885 to other procedures assigned to APC 5465 and because the geometric mean cost for that procedure aligned with the geometric mean cost of APC 5465, we proposed to reassign CPT code 61885 from APC 5464 (Level 4 Neurostimulator and Related Procedures) with a proposed payment rate of $20,126.69 for CY 2026 to APC 5465 (Level 5 Neurostimulator and Related Procedures) with a proposed payment rate of $31,751.65 for CY 2026. We also proposed to continue assigning CPT code 64590 to APC 5464 (Level 4 Neurostimulator and Related Procedures).

We received public comments on these proposals. The following is a summary of the comments we received and our responses.

Comment: Some commenters supported these proposals and other commenters were concerned that since CMS was proposing to reassign CPT code 61885 from APC 5464 to APC 5465, the OPPS proposed payment rate for APC 5464 will decline significantly, when calculated both with and without the comprehensive APC (C-APC) methodology.

A commenter stated that the decrease in the payment rate for services remaining in APC 5464 will limit access for Medicare beneficiaries to important therapies reported under CPT code 64590 and other codes in that APC.

Other commenters requested that CMS utilize the adjustment authority at section 1833(t)(2)(E) of the Act to ensure equitable payments under the OPPS and calculate the OPPS payment rates for APC 5464 with and without the C-APC methodology using a geometric mean cost that phases in the reassignment of 61855.

During the 4-year phase-in, the payment rate calculation for APC 5464 would include a declining share of the mean cost of 61855 according to the following schedule:

2026--75%.

2027--50%.

2028--25%.

2029--0%.

The commenters requested that CMS apply this adjustment only to APC 5464; the calculation of the payment rate for APC 5465 should not be affected by this adjustment.

Response: Under the OPPS, we use the latest claims data to set the annual payment rates. For this final rule with comment period, the OPPS payment rates are based on claims submitted between January 1, 2024, and December 31, 2024, processed through June 30, 2025. Based on our evaluation of the claims data, the geometric mean cost for CPT code 61885 is $31,169.28 based on 3,008 single claims (out of 3,030 total claims), which is much more consistent with the geometric mean cost for APC 5465 (geometric mean cost of $31,767.96) than APC 5464 (geometric mean cost of $19,972.38).

In addition, the geometric mean costs of HCPCS codes that are assigned to APC 5464 are in line with the geometric mean cost for APC 5464. For instance, the geometric mean cost of CPT code 64590 which has over 95 percent of the claims volume in APC 5464, is $20,065.44 based on 11,062 single claims (out of 11,254 total claims) which is comparable with the geometric mean cost of $$19,972.38 for APC 5464.

In summary, after consideration of the public comments, we are finalizing without modification our proposal to assign CPT code 61885 to APC 5465 for CY 2026.

CPT code 61891 (Responsive neurostimulation (RNS)) is an epilepsy treatment that uses an implanted device to help prevent seizures before they begin, similar to how a pacemaker detects and treats abnormal heart rhythms. With RNS, surgeons implant a small battery-powered device called a

neurostimulator in the patient's skull. The neurostimulator is connected to thin wires, which the surgeon places in the area or areas of the brain where the patient's seizures originate. The neurostimulator monitors the brain's electrical activity, and when activity that could lead to a seizure is detected, it delivers a pulse of electrical stimulation that may stop the seizure before it begins. The neurostimulator's battery generally lasts about 11 years. The neurostimulator is surgically replaced on an outpatient basis when the battery is at end of service.

The RNS procedures are described by CPT codes: 61889, 61891 and 61892.

61889--Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s).

61891--Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s).

61892--Removal of skull-mounted cranial neurostimulator pulse generator or receiver with cranioplasty, when performed.

In the CY 2026 OPPS/ASC proposed rule, we proposed to continue assigning CPT code 61889 to status indicator “C” since this procedure is only performed in the inpatient setting. We proposed to continue assigning CPT code 61891 to status “J1”, APC 5464 (Level 4 Neurostimulator and Related Procedures) with a proposed payment rate of $20,126.69 and we proposed to continue assigning CPT code 61892 to status indicator “J1”, APC 5113 (Level 3 Musculoskeletal Procedures) with a proposed payment rate of $3,377.20.

At the August 25, 2025, HOP Panel Meeting, a presenter advised the Panel to request that CMS reassign CPT code 61891 to APC 5465 (Level 5 Neurostimulator and Related Procedures). Based on the information presented at the meeting, the Panel recommended that CMS reassign CPT code 61891 to APC 5465 for CY 2026.

Comment: Commenters disagreed with CMS' assignment of APC 5464 and requested that CMS reassign CPT code 61891 to APC 5465. The commenters cited the inadequacy of APC 5464 from a cost and payment perspective, the fact that the predecessor CPT code 61886 was assigned to APC 5465, and that revision procedures are extremely rare.

A few commenters stated that while they understood CMS' concern about overpaying for a revision procedure that does not involve replacing the neurostimulator, the likelihood of this occurring is extremely rare. One of the commenters noted that based on internal data collected by NeuroPace, the company that manufactures the RNS System, it is less than one case per year across all payers.

Several commenters also noted that in their own practices, they have never performed a revision to the neurostimulator but have performed a number of replacements.

Another commenter stated that the current APC assignment for CPT code 61891 does not adequately reflect hospital costs, nor does it provide adequate outpatient payment for the service.

A few commenters stated that CY 2024 claims data published with the CY 2026 OPPS/ASC proposed rule demonstrates that the geometric mean cost (GMC) of CPT code 61891 is more appropriately aligned with the GMC of APC 5465. The commenter noted that per the Cost Statistics file, CPT code 61891 has a geometric mean cost (GMC) of $32,487. This is significantly higher than the GMC of current APC 5464 ($20,440) and the proposed payment rate of APC 5464 ($20,127). If finalized, hospitals will incur a loss of over $12,000 per procedure in CY 2026 for this procedure.

Some commenters also pointed out that assigning CPT code 61891 to APC 5465 is consistent with the APC assignment for the predecessor CPT code 61886--Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to two or more electrode arrays. Prior to the implementation of CPT code 61891 in January 2024, the replacement of a skull-mounted cranial neurostimulator was reported with CPT code 61886 and assigned to APC 5465. CPT code 61891 was created to differentiate the services associated with skull-mounted cranial neurostimulators and cranial neurostimulators implanted in the chest (for example, CPT code 61886).

Another commenter acknowledged that the volume of procedures coded with CPT code 61891 remains low. However, a further reduction in payment has the potential to create access issues for the vulnerable patient population of patients with intractable epilepsy in whom these neurostimulator are utilized.

Response: We agree with the commenters and the HOP Panel that CPT code 61891 should be reassigned to APC 5465.

After consideration of the public comments we received, we are assigning CPT code 61891 to APC 5465 for CY 2026. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. CPT Code 0786T

Effective January 1, 2024, the CPT Editorial Panel separated integrated from non-integrated (i.e., traditional) sacral neurostimulator procedure by establishing a new CPT code, 0786T to report procedures using integrated sacral neurostimulator devices, while CPT code 64590 was updated to reflect the use of traditional technology:

0786T: Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed.

64590: Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver.

In the CY 2026 OPPS/ASC proposed rule, we proposed to continue assigning CPT code 0786T to status indicator “E1” to indicate that it is still pending the FDA approval. However, this service received FDA approval on June 17, 2025.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: At the August 25, 2025 HOP Panel Meeting, the presenter advised the panel to request that CMS assign CPT code 0786T to APC 5464 (Level 4 Neurostimulator and Related Procedures). The HOP Panel agreed with the presenter and made that recommendation.

A commenter stated CPT code 0786T should not map to the same APC (APC 5464) as the traditional peripheral and sacral nerve stimulation devices that require lead insertion and pocket formation for the insertion of an implanted neurostimulator (INS). The traditional approach for a neurostimulator implant is reported with CPT code 64561 (Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed) or 64555 (Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)) for a percutaneous lead implant. These codes define the trial lead and permanent lead insertion. CPT code (64590 Insertion or replacement of peripheral, sacral, or gastric

neurostimulator pulse. generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver is used to report the insertion of a neurostimulator pulse generator or receiver and requires the creation of a pocket and the connection between the electrode array and the pulse generator). This does not occur with integrated devices. As a predicate, CPT code 64596 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array) is used to report the permanent placement of an integrated system that includes the contacts and the receiver on the other end of the lead and maps to APC 5463 (Level 3 Neurostimulator and Related Procedures). Therefore, the commenter recommended assignment of CPT codes 0786T, to either APC 5462 (Level 2 Neurostimulator and Related Procedures) or APC 5463 as either APC is a more accurate assignment given the cost and resources required to perform the procedure with an integrated device.

Another commenter recommended that we assign CPT code 0786T to APC 5462. CMS has assigned CPT code 0587T, describing the percutaneous implantation of an integrated single-device neurostimulation system for bladder dysfunction targeting the posterior tibial nerve, to APC 5462. The commenter believed that assignment of CPT code 0786T to the same APC as CPT code 0587T (APC 5462) would be much more clinically coherent than assignment to APC 5464, because both procedures involve percutaneous implantation of integrated neurostimulators for the treatment of bladder dysfunction with the only difference being the nerve target (sacral vs. posterior tibial nerve).

Another commenter requested that CMS assign CPT code 0786T to APC 5464 with a status indicator of “J1” based on clinical and resource homogeneity. The commenter believes that assignment to APC 5464 creates clinical alignment with other urinary urge incontinence (UUI) procedures, including both integrated and non-integrated systems.

Response: We thank the commenters for their input. We agree with one of the commenters that APC 5463 is the most appropriate assignment based on the cost and resources required to perform the procedure with an integrated device. Therefore, we are reassigning CPT code 0786T from status indicator “E1” to status indicator “J1”, APC 5463 for CY 2026.

We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. We also refer readers to Addendum D1 to this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. CPT Codes 0817T and 0988T

For CY 2024, the CPT Editorial Panel established four new Category III CPT codes, specifically, CPT codes 0816T, 0817T, 0818T, and 0819T to describe integrated neurostimulation services for bladder dysfunction, effective January 1, 2024.

For CY 2026, we proposed to continue assigning CPT code 0817T--Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subfascial, to APC 5464 with status indicator “J1”.

For CY 2026, CPT Editorial Panel created new Category III CPT code 0988T (placeholder code X400T)--Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subcutaneous and subfascial, effective January 1, 2026.

In the CY 2026 OPPS/ASC proposed rule, we proposed to assign it to APC 5464 with status indicator “J1”.

We received public comments on these proposals. The following is a summary of the comments we received and our responses.

Comment: A commenter recommended assigning CPT codes 0988T and 0817T to either APC 5462 or APC 5463 as either APC is a more accurate assignment given the cost and resources required to perform the procedure with an integrated device.

Another commenter was concerned that the proposed 2026 OPPS payment rate for CPT 0817T is significantly lower than the 2025 rate.

Response: In the CY 2026 OPPS/ASC proposed rule, we inadvertently listed CPT code X400T as receiving FDA-approval even though the Coloplast's implantable tibial nerve stimulator that is described by this code is still pending FDA approval. Therefore, in the Final Rule, we are changing the status indicator for CPT code 0988T to status indicator “E1” Not covered by any Medicare outpatient benefit category; Statutorily excluded by Medicare; Not reasonable and necessary; Not paid by Medicare when submitted on outpatient claims (any outpatient bill type)) for CY 2026 because the device is not yet FDA approved.

We thank the commenters for their feedback related to our proposal for CPT code 0817T and we agree with one of the comments that it is appropriately placed in APC 5464 based on resource cost and clinical homogeneity to other similar codes in that APC. We also believe that its geometric mean cost is in line with the geometric mean cost of APC 5464.

For the CY 2026, based on claims submitted between January 1, 2024, and December 31, 2024, processed through June 30, 2025, our analysis of the latest claims data for this final rule with comment period shows a geometric mean cost of approximately $21,783.06 for CPT code 0817T based on 93 single claims, which is comparable to the geometric mean cost of about $19,972.38 for APC 5464. Based on the data, we continue to believe that assignment to APC 5464 for CPT code 0817T is appropriate.

We refer readers to Addendum D1 to this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addendum D1 is available via the internet on the CMS website. 38. New Technology Applications a. Digital Mental Health Treatment (DMHT), HCPCS Code G0552 (APC 5012)

HCPCS code G0552 (Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan). became effective January 1, 2025, and describes digital mental health treatment devices. We proposed to assign HCPCS code G0552 to APC 5012 (Clinic Visits and Related services) and status indicator V (clinic or emergency department visit) for CY 2026.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Commenters recommended that CMS not finalize the proposal to continue to assign HCPCS code G0552 to APC 5012 for CY 2026, stating that the proposed payment rate of approximately $134 would not cover the costs associated with furnishing the service. A commenter explained that CMS should not use CPT code 98975

(Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment) as a crosswalk code to assign HCPCS code G0552 to APC 5012, noting certain differences between the codes. For example, the commenter explained that HCPCS code G0552 treats a condition while a remote monitoring device is designed to monitor a patient's status at home related to treatment. As a result of these differences, the commenter noted that DMHT devices, like those described by HCPCS code G0552, are significantly more costly to design, develop, study, obtain clearance, and commercialize compared with remote monitoring devices.

Response: We thank the commenters for their input. The New Technology APC application for the service described by HCPCS code G0552 is currently under consideration. After careful review and discussion with our CMS medical officers and leadership, we will render a decision through the subregulatory process through which the New Technology APC placement was initially requested. b. Leadless Pacemaker (WiSE CRT System), CPT Code 0515T (APC 5231)

CPT code 0515T (Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery]) became effective January 1, 2019, and describes the insertion of a wireless cardiac stimulator for left ventricular pacing.

CPT code 0515T is currently assigned to APC 5231 (Level 1 ICD and Similar Procedures) and status indicator of J1 (Hospital Part B Services Paid Through a Comprehensive APC; Paid under OPPS).

For CY 2026, we proposed to continue assignment of CPT code 0515T to APC 5231 (Level 1 ICD and Similar Procedures) with a proposed payment of around $22,725. This code had 2 claims for ratesetting and a geometric mean cost (GMC) of $16,837.74.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 0515T to New Technology APC 1576--Level 39 ($15,001-$20,000) to ensure that there is adequate payment for the non-device costs as this code is tentatively approved for pass-through payment (device costs).

Response: The New Technology APC application is currently under consideration. After careful review and discussion with our CMS medical officers and leadership, we will render a decision through the sub- regulatory process through which the New Technology APC placement was initially requested. We refer the readers to section IV. of this final rule with comment period for a discussion of applications that have been submitted for pass-through payment. c. Paired Vagal Nerve Stimulation (Vivistim[supreg] System), CPT Code 64568 (APC 5465)

The Vivistim[supreg] System is an implanted neurostimulator that is used to stimulate the vagal nerve for upper extremity motor deficits and motor function in chronic ischemic stroke patients with moderate to severe arm impairment. CPT code 64568 (Open implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator) is used to describe the implantation of the Vivistim[supreg] System.

CPT code 64568 is assigned to APC 5465 (Level 5 Neurostimulator and Related Procedures), status indicator of `J1' (Hospital Part B Services Paid Through a Comprehensive APC;) and has a geometric mean cost (GMC) of around $49,319 with 151 single frequency claims used for ratesetting under OPPS. We note that the Vivistim[supreg] System was granted transitional device pass-through status on January 1, 2023, that is set to expire December 31, 2025.

Comment: Many commenters shared their experience with the Vivistim[supreg] System (paired vagus nerve stimulation) noting the effectiveness of the system to restore motor function in patients living with long term disabilities after having a stroke. Many of the commenters expressed concern about the lack of reimbursement once the transitional pass-through payments expire. They encouraged CMS to create a Level 6 Neurostimulator and Related Procedures APC to ensure that there is adequate and sustainable reimbursement for this advanced therapy. Commenters indicate that the current reimbursement for CPT code 64568 will not adequately cover hospital costs, putting access for Medicare beneficiaries at risk.

A commenter provided three options to ensure that there is adequate reimbursement for this advanced neuromodulation. The commenter requested that CMS consider creating a Level 6 Neurostimulator APC that includes CPT code 64568, reassigning 64568 to New Technology APC 1580 (New Technology--Level 43 ($40,001-$50,000)) or creating a C-code through the pending New Technology APC application and assigning the C- code to New Technology APC 1581 (New Technology--Level 44 ($50,001- $60,000)).

Response: We appreciate the input from commenters. As stated earlier in section “36. Creation of a Level 6 Neurostimulator APC”, we are assigning the primary procedure code to New Technology APC 1580 (New Technology--Level 43 ($40,001-$50,000)) in this final rule with comment period. We refer readers to the above noted section for a full discussion of the comments and our responses regarding CPT code 64568. 39. Noncontact Near-Infrared (NIR) Spectroscopy, CPT 0640T (APC 5732)

Effective CY 2024, there are three codes that describe the service related to NIR spectroscopy: CPT codes 0640T (Noncontact near-infrared spectroscopy (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; first anatomic site), 0859T (Noncontact near-infrared spectroscopy (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; each additional anatomic site (list separately in addition to code for primary procedure)), and 0860T (Noncontact near-infrared spectroscopy (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), for screening for peripheral arterial disease, including provocative maneuvers, image acquisition, interpretation, and report, one or both lower extremities). Only CPT code 0640T is currently separately paid under the OPPS. For CY 2026, we proposed to assign CPT code 0640T to APC 5732 (Level 2 Minor Procedures) and status indicator “S” with a payment rate of approximately $39.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 0640T to APC 5722 (Level 2 Diagnostic Tests and Related Services), which had a proposed payment rate of approximately $220 for CY 2026, based on a crosswalk to CPT code 0598T (Noncontact real-time fluorescence wound imaging, for bacterial presence, location, and load, per session; first anatomic site (e.g., lower extremity)). The commentor noted

certain similarities between both codes, such as that CPT code 0640T and CPT code 0598T are both Category III CPT codes, diagnostic imaging services, and neither use contrast.

Response: We note that for CY 2026, OPPS payment rates are based on available CY 2024 claims data. Based on our analysis of the claims data for this final rule with comment period, we found a geometric mean cost of approximately $11 for CPT code 0640T based on 347 single frequency claims (out of 1,067 total claims). In contrast, we found a geometric mean cost of approximately $200 for CPT code 0598T based on 1974 single frequency claims (out of 4,063 total claims). Based on the data, the resource cost associated with noncontact real-time fluorescence imaging (CPT code 0598T), is significantly higher compared to noncontact near- infrared (NIR) spectroscopy (CPT code 0640T). We disagree that the resource costs for NIR spectroscopy is similar to noncontact real-time fluorescence imaging based on the claims data available.

After consideration of the public comment, we continue to believe that CPT code 0640T is appropriately assigned to APC 5732. Therefore, for CY 2026, we are finalizing our proposal to assign CPT code 0640T to APC 5732 as reflected in Table 70. The final CY 2026 OPPS payment rate for all the codes payable under the OPPS can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI meanings for all codes reported under the OPPS. Addendum D1 is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.088

Nuclear Medicine Tests 40. Nuclear Medicine Services: Single-Photon Emission Computed Tomography (SPECT) Studies, CPT 78803 (APC 5592)

CPT code 78803 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (spect), single area (e.g., head, neck, chest, pelvis), single day imaging) describes a SPECT scan to find and map a tumor, inflammatory process, or how a radioactive tracer is distributed in a single body area, like the head, chest, or pelvis. For the CY 2026 OPPS/ASC proposed rule, CPT code 78803 had a geometric mean cost of around $585 and we proposed to reassign the procedure from APC 5593 (Level 3 Nuclear Medicine and Related Services) with a proposed payment rate of around $1,323 to APC 5592 (Level 2 Nuclear Medicine and Related Services) with a proposed payment rate of around $559 and status indicator S (Procedure or service not subject to multiple procedure discounting).

Comment: Commenters objected to the reassignment of CPT code 78803 to APC 5592 and requested that CMS not finalize the proposal but rather maintain the current placement in APC 5593. These commenters stated that the significant payment decrease of 57 percent resulting from the reassignment would limit patient access, affect patient care, and restrict hospitals from offering the test. Most commenters referenced the fact that costs were pulled out of 78803 last year when CMS finalized its policy to separately pay for certain radiopharmaceuticals and stated that physicians and hospitals needed time to properly account for resources and inputs associated with 78803 for services that do not use high-cost radiopharmaceuticals. These commenters requested that CMS collect several years of geometric mean data before reassigning CPT code 78803 from its current APC 5593. A commenter stated that CPT code 78803 should remain in APC 5593 because it is used to report SPECT (not planar) imaging, and other SPECT procedures are assigned to APC 5593.

Response: As acknowledged by commenters, last year we finalized a policy to unpackage diagnostic radiopharmaceuticals with per day costs above an annually adjusted threshold and pay separately for them. As a result of this shift from packaged payment to separate payment, the geometric mean cost for CPT 78803 understandably dropped, from around $1,137 for CY 2024 to around $588 for CY 2025. We appreciate commenters' concerns about providing additional time for hospitals to adjust and for additional geometric mean data to accumulate, however given that costs that were previously packaged into CPT code 78803 are now separately paid as a result of the policy we instituted last year, we think it is appropriate to reassign CPT 78803 to an APC that better aligns with 78803's CY 2026 geometric mean cost of around $585.

After consideration of the public comments we received, we are finalizing our policy without modification for CPT code 78803. We note that we review the APC assignments for all items and services paid under the OPPS on an annual basis. We will reevaluate the APC assignment for CPT code 78803 in the next rulemaking cycle.

Table 71 shows the finalized status indicator and APC assignment for this procedure code. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website.

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CPT code 78800 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (e.g., head, neck, chest, pelvis), single day imaging) describes a planar (2D) nuclear medicine scan of a single area on a single day, used to locate tumors, inflammatory processes, or track the distribution of a radioactive tracer. It includes vascular flow and blood pool imaging if they are performed as part of the study. CPT code 78800 is assigned to APC 5591 (Level 1 Nuclear Medicine and Related Services) and status indicator S (Procedure or Service, Not Discounted When Multiple).

Comment: A commenter stated that CPT code 78800 is assigned to APC 5591 in proposed Addendum B but is assigned to APC 5573 in the proposed “Data Addendum B” and “2 Times Rule” files. The commenter believes that the code assignment to APC 5573 in the “Data Addendum B” and “2 Times Rule” files is incorrect, and that the correct APC assignment for CPT code 78800 is APC 5591.

Response: We agree that the correct APC assignment for CPT code 78800 is APC 5591. However, we note that the proposed 2026 “Data Addendum B” and “2 Times Rule” files (which are available via the internet on the CMS website at https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-p) both indicate that the code is assigned to APC 5591.

The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website. Ophthalmology Related Services 42. Administration of Lacrimal Ophthalmic Insert Into Lacrimal Canaliculus, CPT Code 68841 (APC 5503)

HCPCS code J1096 (Dexamethasone, lacrimal ophthalmic insert, 0.1 mg), describes the drug Dextenza and is a drug indicated for “the treatment of ocular inflammation and pain following ophthalmic surgery” and for “the treatment of ocular itching associated with allergic conjunctivitis.” \25\ Dextenza is administered via a natural opening in the eyelid (called the punctum) and delivers a tapered dose of dexamethasone to the ocular surface for up to 30 days. CPT code 68841 (Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each) describes the insertion of the implant to administer Dextenza.

\25\ See FDA Package Insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/208742s007lbl.pdf.

In the CY 2024 OPPS/ASC final rule with comment period (88 FR 81651 through 81653), we stated that based on the claims data available at the time, we continued to believe that the assignment of CPT code 68841 to APC 5503 (Level 3 Extraocular, Repair, and Plastic Eye Procedures) was appropriate based on the geometric mean costs. We also reiterated our reasoning that CPT code 68841 was appropriately assigned to an OPPS status indicator of “Q1” and ASC payment indicator of “N1.” We continued to believe that CPT code 68841 is mostly performed during ophthalmic surgeries, such as cataract surgeries. A status indicator “Q1,” indicating a conditionally packaged procedure, describes a HCPCS code where the payment is packaged when it is provided with a significant procedure but is separately paid when the service appears on the claim without a significant procedure. Because ASC services always include a surgical procedure, HCPCS codes that are conditionally packaged under the OPPS are generally packaged (payment indictor “N1”) under the ASC payment system. Although interested parties stated this is an independent surgical procedure and should not be packaged into the primary ophthalmic procedure in which the drug and drug administration are associated, we did not agree based on observed clinical patterns of how the drug is used. Based on CY 2023 claims data, out of over 7,000 total frequency claims, CPT code 68841 was used independently only about 2 percent of the time, meaning that the other 98 percent of the time CPT code 68841 had its payment packaged into the primary procedure with which it is associated. These data reinforced our belief that Dextenza and CPT code 68841 are not furnished independently of a surgical procedure and should be packaged into the primary ophthalmic procedure with which the drug and drug administration are associated. While we recognized that there are some claims that may only include CPT code 68841 without a primary ophthalmic surgery on the claim, we did not believe that this is a frequent occurrence based on our claims data and clinical use patterns; as previously mentioned, our claims data showed that only 2 percent of claims are performed independently of another primary procedure.

For CY 2025, we continued to assign CPT code 68841 to APC 5503 (Level 3 Extraocular, Repair, and Plastic Eye Procedures). We also maintained the OPPS status indicator “Q1” and an ASC payment indicator of “N1.”

For CY 2026, we proposed to continue to assign CPT code 68841 to APC 5503 (Level 3 Extraocular, Repair, and Plastic Eye Procedures). We also proposed to continue to assign CPT code to OPPS status indicator `Q1' and an ASC payment indicator of `N1'.

We note that CPT code 68841 does not have any single frequency claims

out of 2,930 total frequency claims. As stated above, this data once again reinforces our belief that Dextenza and CPT code 68841 are not furnished independently of a surgical procedure and should be packaged into the primary ophthalmic procedure with which the drug and drug administration are associated.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Commenters requested that CMS revise the status indicator to `J1' (Hospital Part B Services Paid Through a Comprehensive APC; Paid under OPPS) to allow for separate ASC payment. The commenter stated that Dextenza replaces the use of self-administered eye drops, which can be difficult for some patients to administer and adhere to the regimen. The commenter also stated the lack of payment disproportionately and negatively affects the ASC setting where this procedure is done 80 percent of the time.

The commenter did not agree with CMS that the fact that CPT code 68841 was performed as a standalone procedure a small percentage of the time was adequate justification for assigning a `Q1' status indicator. The commenter stated that CMS is treating this procedure (CPT 68841) differently than the other procedures assigned to APC 5503 with a `J1' status indicator and that there are other comparable drug delivery procedures, specifically CPT codes 64415, 66020, 66030, and 0699T that also have J1 status indicators and receive separate payment in the ASC setting.

Response: We have long maintained that Dextenza is a drug that functions as a surgical supply and should be packaged under our packaging policy at Sec. 419.2(b), which lists the types of items and services for which payment is packaged under the OPPS. Specifically, Sec. 419.2(b)(16) includes drugs and biologicals that function as supplies when used in a surgical procedure as packaged costs. Historically, we have stated that we consider all items related to the surgical outcome and provided during the hospital stay in which the surgery is performed, including postsurgical pain management drugs, to be part of the surgery for purposes of our drug and biological surgical supply packaging policy (79 FR 66875). As such, the drug administration procedure, CPT code 68841, is also supporting the main ocular procedure being performed. CPT code 68841 should, therefore, be packaged as an intraoperative service under Sec. 419.2(b)(14). We do not believe the listed HCPCS codes suggested by the commenter are analogous to CPT code 68841:

64415--Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed; assigned to APC 5443 (Level 3 Nerve Injections), status indicator of `T';

66020--Injection, anterior chamber of eye (separate procedure); air or liquid; assigned to APC 5491 (Level 1 Intraocular Procedures), status indicator of `J1';

66030--Injection, anterior chamber of eye (separate procedure); medication; assigned to APC 5491 (Level 1 Intraocular Procedures), status indicator of `J1'; and

0699T--Injection, posterior chamber of eye, medication; assigned to APC 5491 (Level 1 Intraocular Procedures), status indicator of `J1'.

We disagree with the commenter that lack of payment for the procedure in the ASC setting is a disincentive to use Dextenza. We note the number of claims continue to increase. We also note that HCPCS code J1096, which may be used to describe the drug, Dextenza, is a qualifying product for separate payment in both the OPPS and ASC under our policy to implement section 4135 of the CAA, 2023.

For the reasons discussed, we continue to believe that it is appropriate to assign CPT code 68841 to a status indicator “Q1,” indicating a conditionally packaged procedure, which describes a HCPCS code where the payment is packaged when it is provided with a significant procedure but is separately paid when the service appears on the claim without a significant procedure. Because ASC services always include a surgical procedure, HCPCS codes that are conditionally packaged under the OPPS are generally packaged (payment indictor “N1”) under the ASC payment system.

After consideration of the public comment, we are finalizing our proposal, without modification, to assign CPT code 68841 to APC 5503 with OPPS status indicator “Q1” (STV Packaged Codes) for CY 2026, which typically means there will be a packaged APC payment if this code is billed on the same claims as a HCPCS code assigned to status indictor “S,” “T,” or “V” (Clinic or Emergency Department Visit). In addition, based on the OPPS assignments, we are finalizing an ASC payment indicator of “N1” (Packaged service/item; no separate payment made) for CPT code 68841 for CY 2026.

For the final CY 2026 OPPS payment rates, we refer readers to OPPS Addendum B to this final rule with comment period. In addition, we refer readers to OPPS Addendum D1 to this final rule with comment period for the status indicator definitions for all codes reported under the OPPS. For the final CY 2026 ASC payment rates and payment indicators, we refer readers to Addendum AA and Addendum BB for the ASC payment rates, and Addendum DD1 for the ASC payment indicator and their definitions. The OPPS Addenda B and D1 and ASC Addenda AA, BB, and DD1 are available via the internet on the CMS website. 43. Comprehensive Aqueous Outflow Procedure

The comprehensive aqueous outflow procedure consists of more than 90 degrees of microcatheterization followed by more than 90 degrees of ab interno trabeculotomy used to treat patients with glaucoma.

We received public comments on this topic. The following is a summary of the comments we received and our responses.

Comment: A commenter stated that this service is more complex, utilizes more intraoperative time, and resource utilization. The other commenter stated that the current coding structure does not adequately reflect the differences in procedures currently reported with CPT code 66174 (Transluminal dilation of aqueous outflow canal (e.g., canaloplasty); without retention of device or stent) and the comprehensive aqueous outflow procedure. The commenter indicated that these differences risk limiting hospitals from adopting the procedure and thus hindering patient access. The commenters requested that CMS create a C code and finalize a New Technology APC assignment that appropriately recognizes this unique procedure.

Response: We thank the commenters for their input. After review of the comment, we do not believe the commenter has provided sufficient explanation to justify the creation of a new C-code at this time. Orthopedic Related Services 44. First Carpometacarpal Total Joint Arthroplasty, CPT Code 1003T (APC 5115)

The CPT Editorial Panel established CPT code 1003T to describe a total joint arthroplasty procedure involving the thumb effective January 1, 2026. The long descriptor for CPT code 1003T is as follows: Arthroplasty, first carpometacarpal joint, with distal

trapezial and proximal first metacarpal prosthetic replacement (e.g., first carpometacarpal total joint). Because the final CY 2026 CPT code numbers were not available when we published the CY 2026 OPPS/ASC proposed rule, the code was listed as placeholder code CPT code X459T in the OPPS Addendum B to the CY 2026 OPPS/ASC proposed rule.

For CY 2026, we proposed to assign CPT code 1003T to APC 5114 (Level 4 Musculoskeletal Procedures) and status indicator `J1' (Hospital Part B Services Paid Through a Comprehensive APC; Paid under OPPS.) with a proposed payment of around $7,533 based on clinical similarity to CPT code 26531 (Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint).

At the August 25, 2025, HOP Panel Meeting, a presenter provided information to the Panel regarding new CPT code 1003T. The presenter advised the Panel to request that CMS reassign CPT code 1003T from APC 5114 to APC 5116. The HOP Panel agreed with the presenter and recommended that CMS reassign CPT code 1003T to APC 5116 (Level 6 Musculoskeletal Procedures), with a proposed payment of $18,056.80.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Commenters noted that while other hand and wrist procedures are assigned to APC 5114, this procedure involves a total joint reconstruction with an implantation of a complex and costly prosthesis. The commenter believes that CPT 1003T is more similar to other arthroplasty procedures in APC 5116 suggesting CPT code 25446 (which describes a total wrist arthroplasty) and CPT code 25442 (which describes a distal ulna arthroplasty) as appropriate crosswalks. Commenters urged CMS to reassign CPT code 1003T to APC 5116 (Level 6 Musculoskeletal Procedures) as the HOP Panel recommended.

Response: We agree with the commenters that CPT code 1003T should not be assigned to APC 5114; however, we disagree that CPT code 1003T should be reassigned to APC 5116. After reviewing the comments and taking into consideration the HOP Panel recommendation, we believe that CPT code 1003T should be reassigned to APC 5115 crosswalking to CPT code 25441 (Arthroplasty with prosthetic replacement; distal radius). As we do every year, we will reevaluate the APC assignments for this code in the next rulemaking cycle. We remind hospitals that we review, on an annual basis, the APC assignments for all items and services paid under the OPPS.

In summary, after consideration of the public comments we received, we are finalizing the APC and status indicator assignment for CPT code 1003T with modification and assigning CPT code 1003T to APC 5115 (Level 5 Musculoskeletal Procedures) with a status indicator of J1. The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the SI definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website.

Refer to Table 72 for code descriptor, APC assignment and status indicator assignment for CPT code 1003T for CY 2026. [GRAPHIC] [TIFF OMITTED] TR25NO25.090

CPT code 28740 (Arthrodesis, midtarsal or tarsometatarsal, single joint) describes the fusion of foot bones. In the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign CPT code 28740 to APC 5114 (Level 4 Musculoskeletal Procedures) with a status indicator of `J1' (Hospital Part B Services Paid Through a Comprehensive APC; Paid under OPPS) and proposed payment rate of $7,533.87.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter stated that the assignment of CPT code 28740 to APC 5114 may represent a violation of the 2 times rule, which may impede access to care for beneficiaries. The commenter recommended that CMS consider a volume threshold of 500 single major claims (or the existing greater or equal to 99 claims that constitute greater than or equal to the 2 percent criterion) as the standard for designating an item or service “significant” for purposes of the 2 times rule.

Response: We appreciate the commenter's request. We did not identify a 2-times rule violation for APC 5114. Our updated claims data found CPT code 28740 has fewer than 1,000 claims and does not meet the significance threshold for the 2-times rule evaluation for APC 5114. We believe that the current APC assignment of CPT code 28740 to APC 5114 continues to be appropriate for CY 2026.

However, we will take the commenter's suggestion on the 500-claim significance threshold into consideration for the future rulemaking.

In summary, after consideration of the public comments we received, we are finalizing our proposal without modification, to assign CPT code 28740 to APC 5114 (Level 4 Musculoskeletal Procedures). The final CY 2026 payment rates for this code can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 to this final rule with comment period for the status indicator definitions for all codes reported under the OPPS. Addenda B and D1 are available via the internet on the CMS website.

Refer to Table 73 for code descriptor, APC assignment and status indicator

assignment CPT code 28740 for CY 2026. [GRAPHIC] [TIFF OMITTED] TR25NO25.091

Oncology Related Services 46. Radiation Oncology Treatment Delivery, CPT Codes 77402, 77407, 77412 (APCs 5621, 5622, and 5623)

At the September 2024 CPT Editorial Panel meeting, the Panel approved the revision of radiation therapy CPT codes 77402, 77407 and 77412 to establish a technique-agnostic family of codes and bundle imaging into the three CPT codes. In addition, Intensity Modulated Radiation Therapy (IMRT) treatment delivery codes 77385 and 77386 and CT guidance code 77014 were deleted and consolidated into this new code structure:

Revised CPT code 77402 (Radiation treatment delivery; Level 1 (e.g., single electron field, multiple electron fields, or 2D photons), including imaging guidance, when performed) describes the delivery of a low-complexity form of radiation to a cancer or tumor and includes any imaging that is used during the session to ensure the radiation beam is accurately targeting the cancer. For the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign CPT code 77402 to APC 5621 (Level 1 Radiation Therapy), which has a payment rate of around $108, and status indicator S (Procedure or service not subject to multiple procedure discounting).

Revised CPT code 77407 (Radiation treatment delivery; Level 2, single isocenter (e.g., 3D or IMRT), photons, including imaging guidance, when performed) describes the delivery of a more complex form of radiation using a single central point of radiation (isocenter) with high-energy photons which may be delivered through 3D conformal radiation therapy (3D-CRT) or Intensity-Modulated Radiation Therapy (IMRT) and includes any imaging that is used during the session. For the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign CPT code 77407 to APC 5622 (Level 2 Radiation Therapy), which has a payment rate of around $275, and status indicator S.

Revised CPT code 77412 (Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (e.g., 2D, 3D, or IMRT) OR a single isocenter photon therapy (e.g., 3D or IMRT) with active motion management, OR total skin electrons, OR mixed electron/ photon field(s), including imaging guidance, when performed) describes the most complex radiation treatment delivery where multiple points of focus (isocenters) are used with photon therapy (2D, 3D, or IMRT) or a single isocenter is used but with active motion management or specialized techniques like total skin electrons or mixed electron/ photon beams are performed and includes any imaging that is used during the session. For the CY 2026 OPPS/ASC proposed rule, we proposed to continue to assign CPT code 77412 to APC 5622 (Level 2 Radiation Therapy), which has a payment rate of around $275, and status indicator S.

A comment letter was submitted to the HOP Panel in advance of the August 25, 2025 HOP Panel Meeting that provided information about CPT codes 77407 and 77412. The letter advised the Panel to request that CMS reassign CPT code 77407 to APC 5623 and CPT code 77412 to APC 5624 for CY 2026. The HOP Panel had no recommendations.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: Many commenters expressed concern that CMS' proposed APC assignments for CPT codes 77407 and 77412 did not adequately reflect the procedures described by the revised codes and would not provide sufficient payment. Many commenters pointed out that these revised codes now included 3D conformal and IMRT treatment delivery that were previously described by deleted CPT codes 77385 and 77386. Several commenters suggested that for the purposes of rate setting, CMS should treat the three revised CPT codes as new codes. A commenter stated that “[a]lthough the CPT code numbers are the same for the remaining three CPT codes in the new treatment delivery family, they represent completely different services. For HOPPS rate setting purposes, CMS should treat 77402, 77407, and 77412 as new codes.”

Several commenters suggested alternative APC assignments, recommending that CPT code 77407 be reassigned from APC 5622 to APC 5623 (Level 3 Radiation Therapy), which has a CY 2026 proposed payment rate of around $600. These commenters reasoned that reassigning CPT code 77407 to APC 5623 would more accurately reflect the higher resource utilization associated with IMRT. On the same basis, roughly half of these commenters suggested that CPT code 77412 be reassigned from APC 5622 to APC 5623 and the other half suggested reassignment to APC 5624 (Level 4 Radiation Therapy) with a CY 2026 proposed payment rate of $716. Proponents of reassignment to APC 5624 stated that the higher APC assignment was warranted as CPT code 77412 is intended to account for the highest complexity therapy and such therapy requires additional time and incremental capital equipment resources to deliver multi-isocenter treatments and active motion management. Finally, a few commenters suggested that CPT code 47702 be reassigned from APC 5621 to APC 5622.

Response: We agree with commenters that the proposed APC assignments and the resulting payment rates for CPT codes 77407 and 77412 could more properly account for the revisions made to those codes and that the geometric mean costs of CPT codes 77385 ($568) and 77386 ($634) should be considered when assigning the appropriate APC for these codes. Accordingly, to establish a geometric mean cost for CPT codes 77407 and 77412 that better reflects the geometric mean costs under CPT codes 77385 and 77386, we have crosswalked the claims volume of CPT codes 77385, 77386, 77407, and 77412 in the following manner: For CPT code 77407, we are imputing all CY 2024 claims in CPT code 77407, the bottom 50 percent (with respect to total estimated cost) of single claims from CPT code 77412, and

all of the claims from CPT code 77385. For CPT code 77412, we are imputing the highest 50 percent (with respect to total estimated cost) of claims in 77412, and all of the claims from 77386. As a result of this crosswalking of claims, we are continuing to assign CPT code 77407 to APC 5622, which now has a geometric mean cost of around $397 and reassigning CPT code 77412 to APC 5623, which now has a geometric mean cost of around $569. We note that, while CPT code 77407 is assigned to the same APC it was assigned in the CY 2026 OPPS/ASC proposed rule, as a result of the crosswalk described above, the payment rate for that APC is much greater than it was in the CY 2026 OPPS/ASC proposed rule. With respect to 77402, we disagree with commenters that reassignment to APC 5622 is appropriate. Unlike CPT codes 77407 and 77412, CPT code 77402 was not revised to incorporate IMRT which is the basis for the crosswalk/APC reassignment for CPT codes 77407 and 77412 above.

We note that we received a few comments on our proposal that, due to the proposed deletion of radiation therapy G-codes (G6001-G6017), nonexcepted off-campus PBDs use the revised CPT codes 77402, 77407 and 77412 to continue our existing policy of paying the PFS-equivalent rate for radiation therapy to these departments. For a summary of and response to those comments, we refer readers to section III.G. of this final rule with comment period.

After consideration of the public comments we received, we are: (1) finalizing as proposed to continue to assign CPT code 77402 to APC 5621 and CPT code 77407 to APC 5622, while noting that the payment rate for APC 5622 is much greater than in the CY 2026 OPPS/ASC proposed rule as a result of the above code crosswalk; and (2) reassigning CPT code 77412 to APC 5623. We note that we review the APC assignments for all items and services paid under the OPPS on an annual basis. We will reevaluate the APC assignments for CPT codes 77402, 77407 and 77412 in the next rulemaking cycle.

Table 74 shows the finalized status indicator and APC assignment for these procedure codes. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.092

CPT code 20982 (Ablation therapy for reduction or eradication of 1 or more bone tumors (e.g., metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency) describes a primarily palliative procedure that reduces the size of bone tumors and addresses the pain from the tumors. For the CY 2026 OPPS/ASC proposed rule, CPT code 20982 had a geometric mean cost of around $18,375 and we proposed to continue to assign the procedure to APC 5115 (Level 5 Musculoskeletal Procedures), which has a proposed payment rate of around $13,254.

We received public comments on this proposal. The following is a summary of the comments we received and our responses.

Comment: A commenter requested that CMS reassign CPT code 20982 from APC 5115 to APC 5116 (Level 6 Musculoskeletal Procedures) with a payment rate of around $18,057. The commenter noted that according to the CY 2026 OPPS/ASC proposed rule cost statistics file, CPT code 20982 has a geometric mean cost of approximately $18,375, which exceeds the overall APC cost of $13,461 by nearly $5,000 or 36 percent. In contrast, the commenter pointed out that the overall cost of APC 5116 is $18,338, which very closely aligns with the cost of CPT code 20982. The commenter also noted that the cost of the bone tumor ablation procedure exceeds that of 10 procedures proposed for assignment to APC 5116 with claims data, including two of the three procedures with significant volume in the APC (described by CPT codes 22612

and 27279), which have costs that are over $1,000 less than CPT code 20982. The third procedure with significant volume in APC 5116, described by CPT code 23472, has a geometric mean cost of $18,452, which is nearly identical to CPT code 20982.

Response: After reviewing the information provided by the commenter, the claims data and input from our CMS Medical Officers, we agree with the commenter that it is appropriate to reassign CPT code 20982 from APC 5115 to 5116 based on the resource costs related to CPT code 20982.

After consideration of the public comments we received, we are assigning CPT code 20982 to APC 5116 (Level 6 Musculoskeletal Procedures). Table 75 shows the finalized status indicator and APC assignment for this procedure code. We refer readers to Addendum B to this final rule with comment period for the payment rates for all codes reportable under the OPPS. Addendum B is available via the internet on the CMS website. [GRAPHIC] [TIFF OMITTED] TR25NO25.093