On August 18, 2026, the Centers for Medicare & Medicaid Services (CMS) released its quarterly update to the HCPCS Level II code set. These changes are crucial for healthcare professionals, suppliers, manufacturers, and payers to ensure accurate coding, appropriate billing, and compliance with Medicare and Medicaid regulations. The newly updated codes will become effective October 1, 2026.
A wide range of products, supplies, and services are identified using HCPCS Level II (Healthcare Common Procedure Coding System) codes, which are not covered by the American Medical Association’s CPT® (Current Procedural Terminology) code set. Items such as durable medical equipment, prosthetics, orthotics, certain drugs, wound dressings, and other healthcare-related supplies and services are primarily coded with these codes.
Highlights of the October 2026 Update
CMS’s quarterly update for October 2026 introduces a significant number of changes, summarized as follows:
- 88 new HCPCS Level II codes have been added.
- 14 codes have been deleted to remove obsolete or redundant entries.
- 11 codes have undergone long descriptor changes, providing greater clarity, specificity, or inclusivity.
- 5 codes feature payment changes to better reflect updated reimbursement strategies or product costs.
- 1 code has an administrative field change, reflecting minor adjustments to code details.
These updates play a vital role in ensuring that the coding system stays current with technological advances, newly available medical products, and the evolving needs of healthcare providers and patients.
How New Codes Are Created: The Public Request Process
One of the unique features of the HCPCS Level II system is its openness to stakeholder input. Anyone—including clinicians, manufacturers, suppliers, and individual practitioners—may submit a formal request for a change, addition, or deletion in the code set. This participatory process is designed to ensure that the code set remains responsive to new technologies and clinical practices.
CMS facilitates biannual public meetings where applicants and stakeholders can present their case for new codes or code revisions. During these sessions, additional data, clinical justifications, and real-world use cases are considered. For the October 2026 update, 15 out of the 88 new codes were the direct result of such stakeholder requests, demonstrating CMS’s commitment to transparency and responsiveness.
Detailed Review of Notable New Codes
Below is an expanded look at several of the most significant new codes finalized by CMS for the October 2026 update:
Wound Care and Dressings
- A2046 – Dermisphere hDRT, per square centimeter (Add-on):
This code was finalized for the DermiSphere™ hDRT composite biodegradable wound dressing. It is an add-on code, meaning it’s billed in addition to a primary procedure, and is used to specify the area treated in square centimeters. This dressing is designed to support the healing of complex wounds by providing a biodegradable matrix. - A2047 – LacertaMatrix, per square centimeter (Add-on):
This code identifies LacertaMatrix, a sterile, single-use collagen matrix utilized in wound management. Like other add-on codes, it allows for detailed billing by the area of application. - A2048 – Puraply MZ, per milligram:
Designed for the PuraPly® MZ wound dressing, this code is used to bill by the milligram, supporting the management of various wound types with a focus on precision billing and traceability. - A2049 – Theracor, per square centimeter (Add-on):
The Theracor™ medical device is indicated for both acute and chronic wound management. This add-on code allows clinicians to bill for the specific area treated, offering flexibility for complex wound care scenarios. - A2050 – Fibrillar Collagen Wound Dressing, per milligram:
This advanced, single-use collagen matrix is intended for wounds with moderate to heavy exudation and for controlling minor bleeding. Medicare payment for this code is contractor-based, which means reimbursement may vary depending on the region or Medicare Administrative Contractor.
Infusion and Pump Supplies
A4228 – Supplies for Maintenance of Non-Insulin, Device-Drug Combination Infusion Catheter (per week):
This code is for supplies used with device-drug combination infusion pumps, like the VYAFUSER™ pump. The fee is based on 2.5 units of HCPCS code A4222. This reflects changing supplies every three days. The average non-rural fee schedule is about $124.54 per week.
E0788 – Ambulatory Infusion Pump, Specific Device-Drug Combination:
This code covers external infusion pumps. These pumps may have single or multiple channels. They can be electric or battery powered and are worn by the patient. The code includes unique device-drug combinations, such as the VYAFUSER™ pump. Rental fees are 314.22permonth∗∗forthefirstthreemonths.Formonthsfourthroughthirteen,thefeeis∗∗235.66 per month. After 13 months of continuous use, the total cost is $3,299.26.
Ocular Devices
- A6614 – Supplies and Accessories for Use with External Ocular Negative Pressure Pump, Any Type, per month:
Describes supplies for the FSYX™ Ocular Pressure Adjusting Pump Goggles, supporting ongoing management for patients requiring ocular pressure adjustments. The 2026 fee is set at $167.99 per unit. - E2403 – External Ocular Negative Pressure Pump, Electric:
This code identifies the FSYX™ Ocular Pressure Adjusting Pump itself, an electric device indicated for the treatment of glaucoma in patients with intraocular pressure above 21 mmHg. It expands coding options for modern glaucoma management technologies.
Orthotics and Prosthetics
- L1330 – Thoracic Orthosis, Sternal and/or Sternocostal Compression:
Designed for the CoreTech® sternocostal orthosis, this code covers prefabricated braces used in nonoperative management of costochondritis and related chest wall disorders. It includes all necessary fitting and adjustment procedures. - L1972 – Ankle Foot Orthosis, Prefabricated, Off-the-Shelf:
This code describes a prefabricated, off-the-shelf ankle foot orthosis with an ankle joint, with or without dorsiflexion assist. The related code, L1971, has been revised to clarify that it now refers to custom-fitted prefabricated devices. - L8697 – External Accessory for Use with Implantable Phrenic Nerve Stimulation Device, Replacement:
This code is designated for the NeuRx® Diaphragm Pacing System external pulse generator and bundled replacement components like surface electrode pads. The overlap with previous code L8696 means that code will be discontinued as of October 1.
Allografts and Wound Coverings
- Q4207 – Carbon Life, per square centimeter (Add-on):
Used for Carbon Life, an allograft wound covering that provides environmental protection to wounds. - Q4223 – DermaBlind SL Optic™, per square centimeter (Add-on):
Targets ocular wound coverage for both acute and chronic eye wounds. - Q4243 – AmchoMatrix, per square centimeter (Add-on):
Refers to an allograft wound covering intended as a barrier and cover for acute or chronic wounds.
Key Code Revisions and Descriptor Updates
11 codes have been updated with new long descriptors, three of which are particularly notable for stakeholders in the breast prosthesis market:
- L8030 & L8031 – Breast Prosthesis, Any Type:
These codes now describe “any type” of breast prosthesis, with or without adhesive, including the Amoena Adapt Air™. The average 2026 fee schedule amount for these codes is $430.74. - L8035 – Custom Breast Prosthesis, Any Type:
Revised to encompass “any type” of custom breast prosthesis, including the Amoena Custom Adapt Air™. The fee schedule amount for 2026 is $4,505.38.
These changes ensure more flexible and inclusive billing for a wider range of prosthetic devices and patient needs.
Deleted Codes, Payment, and Administrative Changes
- 14 codes were deleted, streamlining the code set and removing outdated or unused entries.
- 5 codes received payment changes, reflecting updated cost structures or reimbursement policies.
- 1 code experienced an administrative field change, a minor update to its classification or supporting information.
Impact and Next Steps
The October 2026 update to the HCPCS Level II code set shows CMS’s commitment to keeping coding timely and relevant. CMS gathers public feedback and adopts new medical technologies. The administration also revises code descriptions for inclusivity. These actions support efficient healthcare administration and accurate reimbursement. Healthcare professionals, suppliers, and billing specialists should review the changes. They need to add the new codes to their systems before October 1, 2026. This ensures compliance and the best patient care.