October 2026 CLFS update: new PLA codes are contractor-priced

CMS issued Change Request 14569 on August 24, 2026, as Transmittal 13884 to the Medicare Claims Processing Manual. MLN Matters MM14569 is the provider education (PDF last-modified August 25, 2026, 14:51 GMT).

This is the October 2026 quarterly update to the Clinical Laboratory Fee Schedule (CLFS) and Clinical Laboratory Improvement Amendments (CLIA): HCPCS codes, waived tests, and reasonable charge payments. Effective date is October 1, 2026 (date of service). Implementation date is October 5, 2026.

It is not Tuesday's October 2026 HCPCS file / G0685. That ZIP is Level II file-load. This CR is the CLFS/CLIA quarterly for labs.

What changed in the file

CR 14569 combines three former recurring updates into one: quarterly CLFS, annual CLIA edits and new waived tests, and quarterly CLIA edits and new waived tests.

CMS says the new codes on tab Q4 New Codes "were added to the national HCPCS file with an effective date of October 1, 2026, and do not need to be manually added to the HCPCS files by the MACs." MM14569 repeats that.

Counted from the CR attachment, not from a blog list:

Do not rebuild the CDM from a 39-code listicle. Use the CR attachment tab Q4 New Codes / Q4 Deleted Codes.

Contractor-priced until nationally priced

CMS also says those new codes "are contractor-priced (where applicable) until they are nationally priced and undergo the CLFS annual payment determination process" under SSA §§ 1833(h)(8), 1834A(c), and 1834(A)(f). MACs shall only price PLA codes for laboratories within their jurisdiction.

CLIA and QW

Rows with N in the "CLIA waived? Y or N" column are subject to CLIA edits. CMS requires a certificate of registration (type 9), compliance (type 1), or accreditation (type 3).

Rows with Y are FDA-waived under CLIA. The HCPCS code must include modifier QW to be recognized as waived (Claims Processing Manual Chapter 16, section 70.8). The one Y row in this attachment is 0442U-QW.

CMS will not have MACs search their files to retract or retroactively pay claims. They will adjust claims you bring to their attention.

What this is not

It is not a CMS-HCC or V28 mapping change. PLA codes are laboratory HCPCS. They do not assign an HCC. 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 Coding Guidelines. That PDF is still marked not yet available on the CMS ICD-10 page.

What to do before October 1

1. Load CR 14569's Q4 tabs into the encoder, CDM, and lab billing system. Confirm 0660U-0698U as adds and 0556U, 0557U, 0585U as deletes.

2. Mark the new PLA codes contractor-priced until they appear as nationally priced on the CLFS / IOCE. Do not invent a national fee.

3. Ask the MAC that has the performing lab how it will price that PLA. Out-of-jurisdiction PLA pricing is not in this CR.

4. Bill QW only where the attachment (or the prior waived-test instruction) says the test is waived.

Look up the long descriptor in the encoder or the code book after you load the file. Do not copy a vendor list of 39 names.