CMS WatchAugust 19, 2026·4 min read

CMS January 2027 NCD CRs add FY2027 ICD-10 codes to coverage edits

Transmittals 13906 and 13923 tell MACs to add new ICD-10-CM codes to NCD coverage lists for ICD implants, NGS, PET, transplants, and other policies. CMS says no NCD policy is changing. Implementation is January 4, 2027; most code adds are effective October 1, 2026.

NCDICD-10-CMJanuary 2027CMS Watchcoverage edits

By the HCC Buddy Coding Team

Published August 19, 2026

A coder desk with a codebook, folders, and a highlighter, standing in for the January 2027 NCD ICD-10 coverage-edit update. — CR 14537 and CR 14570 are quarterly NCD ICD-10 maintenance updates. CMS says no coverage policy is changing. — Image: HCC Buddy

Key Takeaways

→CMS issued two January 2027 NCD coding CRs: Transmittal 13906 (CR 14537, August 7) and Transmittal 13923 (CR 14570, August 14, replacing Transmittal 13903).
→CMS states these are quarterly ICD-10 maintenance updates. No NCD policy is being changed.
→The CRs are effective January 1, 2027, with an implementation date of January 4, 2027. Most of the listed ICD-10 adds are effective October 1, 2026, when the FY 2027 codes start.
→NCD 20.4 (ICD) end-dates I42.0 and I42.8 on September 30, 2026, and adds I42.00, I42.01, I42.09, I42.81, I42.89, and I47.22 on October 1, 2026.
→This is not a CMS-HCC or V28 model update, and it is not the FY 2027 IPPS Table 6 file list.

CMS posted the January 2027 quarterly maintenance update of ICD-10 coding conversions and other coding updates specific to National Coverage Determinations. The instructions are in two one-time notifications: Transmittal 13906 / CR 14537 (August 7, 2026) and Transmittal 13923 / CR 14570 (August 14, 2026). Transmittal 13923 rescinds and replaces Transmittal 13903 to add Place of Service, CARC, and RARC business requirements for NCD 20.4.

Both CRs say the same thing up front: this is a quarterly maintenance update. No policy is being changed as a result of these updates. Coverage criteria stay in the NCD. What changes is the code list MACs use to edit claims.

This is not the FY 2027 ICD-10-CM addenda page, and it is not the FY 2027 IPPS Table 6A-6K file list. It is also not a CMS-HCC mapping change.

How the January 2027 dates line up

The CRs are effective January 1, 2027. Implementation is January 4, 2027. Many of the ICD-10 lines themselves are effective October 1, 2026, which is when the FY 2027 diagnosis and procedure codes start.

A few lines are older than that. NCD 270.3 adds place of service 32 effective January 1, 2024. NCD 90.2 adds CPT 81479 for Guardant360 Liquid CDx effective FDA approval May 19, 2026. NCD 20.4 adds POS 11 effective October 20, 2023.

What CR 14570 adds (Transmittal 13923)

CMS tells contractors to update these NCD edit lists:

NCD	What the transmittal tells MACs to do
190.3 Cytogenetic Studies	Add ICD-10-CM C78.31, C78.32, and C79.83 to MAC discretionary covered indications, effective October 1, 2026.
20.30 Microvolt T-wave (MTWA)	Add ICD-10-CM I47.22 and I49.82, effective October 1, 2026.
260.5 Intestinal and Visceral Transplantation	Add ICD-10-CM K76.83, effective October 1, 2026.
20.4 Implantable Cardioverter Defibrillators	End-date I42.0 and I42.8 from Groups 1 and 2 effective September 30, 2026. Add I42.00, I42.01, I42.09, I42.81, I42.89, and I47.22 to Groups 1 and 2 effective October 1, 2026.
220.6.17 PET (FDG) for Oncologic Conditions	Add ICD-10-CM C78.31, C78.32, and C79.83, effective October 1, 2026.
260.1 Adult Liver Transplantation	Add ICD-10-CM K76.83 and K74.0A, effective October 1, 2026.

For NCD 20.4, Transmittal 13923 also adds claims-processing rules for extracorporeal (EVICD) services: return as unprocessable when billed in a place of service other than 11, 19, 21, 22, 24, or 26, using CARC 58, group code CO, and RARC N428. It also tells contractors to add POS 11 effective October 20, 2023.

The NCD spreadsheets for this CR are posted at Medicare-Coverage-DeterminationProcess-CR14570.zip. CMS posted the provider-education article MM14570 on August 18, 2026. It names those six NCDs. It does not list the ICD-10 codes. Those are in Transmittal 13923.

What CR 14537 adds (Transmittal 13906)

NCD	What the transmittal tells MACs to do
270.3 Blood-Derived Products for Chronic Non-healing Wounds	Add place of service 32 (Nursing Facility), effective January 1, 2024.
90.2 Next Generation Sequencing (NGS)	Add CPT 81479 (unlisted molecular pathology procedure for cell-free DNA tests) for Guardant360 Liquid CDx, effective FDA approval May 19, 2026, until a specific PLA code is established.
110.18 Aprepitant	Add ICD-10-CM C78.31, C78.32, and C79.83, effective October 1, 2026.
150.3 Bone Density	Add ICD-10-CM Q87.A, effective October 1, 2026.
220.4 Mammograms	Add ICD-10-CM N99.860 and N99.861, effective October 1, 2026.
250.4 Treatment for Actinic Keratosis	Add ICD-10-PCS 3E00XGF, effective October 1, 2026.

The NCD spreadsheets for this CR are posted at Medicare-Coverage-DeterminationProcess-CR14537.zip. CMS posted the provider-education article MM14537 on August 14, 2026. It names those six NCDs. It does not list the ICD-10 codes. Those are in Transmittal 13906.

Both CRs tell contractors not to search for claims. They can adjust claims brought to their attention.

What this is not

It is not a change to the NCD coverage criteria. CMS repeats that coding and payment are separate from coverage policy, and that these revisions are not intended to change the original intent of the NCD.

It is not a CMS-HCC or V28 model update. If the question is risk adjustment, use the model year you are actually coding in ICD-10 to HCC.

It is not the FY 2027 ICD-10-CM code-change list. That page is the classification addenda. This CR only updates NCD edit lists.

It is not the housing Z-code CC-to-NonCC IPPS note. That is an MS-DRG severity flag, not an NCD coverage list.

It is not the October 2026 NCD CR 14464 / MM14464 maintenance article. That CR is a different quarterly update. Transmittal 13923 is the January 2027 pair.

The official FY 2027 ICD-10-CM Coding Guidelines PDF is still marked "not yet available" on the CMS ICD-10 page (page last modified June 5, 2026). Do not treat this NCD CR as a substitute for those guidelines.

Where the NCD spreadsheets live

Pull the two spreadsheet zips and compare them to your NCD edit file, LCD companion, or encoder coverage notes for the NCDs in the tables above. Look up each diagnosis or procedure code in the encoder against the FY 2027 tabular before October 1 discharges. The CR does not publish code titles.

Prior NCD ICD-10 quarterly files stay on the CMS NCD ICD-10 page.

What coders should do now

1Pull the two spreadsheet zips and compare them to your NCD edit file, LCD companion, or encoder coverage notes for the NCDs in the tables above.
2For ICD implant claims, stop using I42.0 and I42.8 after September 30, 2026. The transmittal moves Groups 1 and 2 to I42.00, I42.01, I42.09, I42.81, I42.89, and I47.22 on October 1.
3For NGS claims that currently depend on an unlisted molecular pathology code, note CPT 81479 for Guardant360 Liquid CDx until CMS assigns a PLA code.
4Look up each diagnosis or procedure code in the [encoder](/encoder) against the FY 2027 tabular before October 1 discharges. The CR does not publish code titles.

Frequently Asked Questions

When do the January 2027 NCD ICD-10 coding revisions take effect?

CR 14537 and CR 14570 are effective January 1, 2027. CMS set the implementation date as January 4, 2027. Most of the ICD-10 diagnosis and procedure codes listed in the business requirements are effective October 1, 2026.

Which ICD-10 codes does CMS add to NCD 20.4 for implantable defibrillators?

Transmittal 13923 tells contractors to end-date I42.0 and I42.8 from Groups 1 and 2 on September 30, 2026, and to add I42.00, I42.01, I42.09, I42.81, I42.89, and I47.22 effective October 1, 2026.

Does this change CMS-HCC mapping or NCD coverage criteria?

No. Both transmittals say no policy is being changed. CMS describes these as quarterly ICD-10 maintenance updates to NCD edit lists. They do not revise the CMS-HCC risk-adjustment model.