October 2026 OPPS update (CR 14589 / R13978CP): PLA, Cat III, drugs, and I/OCE for Oct 1

On September 29, 2026, the Centers for Medicare & Medicaid Services issued Transmittal 13978 / Change Request 14589, *October 2026 Update of the Hospital Outpatient Prospective Payment System (OPPS)*. The instruction rescinds and replaces Transmittal 13913 (August 12, 2026). Effective date: October 1, 2026. Implementation date: October 5, 2026.

For outpatient coding and billing desks staging October OPPS files, this is the quarterly coding and payment-file CR: new PLA and Category III CPT loads, drug and radiopharmaceutical status-indicator moves, skin-substitute HCPCS, and Claims Processing Manual clarifications for modifier CA, critical care, and trauma activation.

What CR 14589 changes for the OPPS desk

CMS says the CR describes changes to and billing instructions for payment policies implemented in the October 2026 OPPS update. The October 2026 I/OCE will reflect the HCPCS, Ambulatory Payment Classification (APC), HCPCS modifier, and revenue-code additions, changes, and deletions identified in this CR. Detailed I/OCE specifications ship in companion Transmittal 13979 / CR 14594 (I/OCE Specifications Version 27.3), also dated September 29, 2026.

Coding loads effective October 1, 2026

1. Proprietary Laboratory Analyses (PLA). The AMA CPT Editorial Panel established 39 new PLA codes, CPT 0660U through 0698U, effective October 1, 2026. Table 1, Attachment A, lists long descriptors and status indicators. Codes are also in the October 2026 OPPS Addendum B.

2. New Category III CPT codes. CMS is implementing 58 new CPT Category III codes that AMA released in early August 2026 for October 1, 2026 implementation. Status indicators and APC assignments are in Table 2, Attachment A, and in October OPPS Addendum B.

3. CPT 1091T replaces HCPCS C8010. CMS established C8010 for the Category B IDE clinical study associated with Javelin Medical carotid implants for permanent placement of common carotid artery filters. Because AMA created Category III CPT 1091T effective October 1, 2026, for the same procedure, CMS is deleting HCPCS C8010. Tables 3 and 4, Attachment A, carry the IDE study info and the SI/APC lines for 1091T and deleted C8010.

4. HCPCS G0685 (ASD algorithm assessment). CMS is establishing G0685 effective October 1, 2026, for algorithm-based assessment of likelihood of autism spectrum disorder from analysis of eye-gaze data or other technology (Table 5, Attachment A). For desk context on that single HCPCS line, see the live tip October 2026 HCPCS G0685 ASD algorithm assessment. This OPPS piece does not rewrite that tip; treat G0685 here as one October OPPS Addendum B / Attachment A line item among the quarterly file changes.

5. Other SI/APC and descriptor moves called out in the policy section. CPT 1011T (photobiomodulation therapy of the oral cavity during radiation therapy) moves off SI E1 to separately payable OPPS status after FDA De Novo classification of the associated device (Table 6). CMS also revises long descriptors for HCPCS C1982, C9797, and C8004 (Table 7).

Do not invent PLA, Category III, or drug descriptors from this article. Pull Attachment A and the October 2026 OPPS Addendum B from CMS.

Drugs, biologicals, and radiopharmaceuticals

Section 9 of CR 14589 is the outpatient pharmacy / nuclear-medicine lane for October:

CMS also points desks to the October 2026 OPPS Addenda A and B on the Hospital Outpatient PPS page for updated ASP-based payment rates (not reprinted inside the CR body).

Manual updates: modifier CA, critical care, trauma activation

CR 14589 revises Pub. 100-04 Chapter 4 as follows:

• Section 20.6.7 Modifier CA updated to: HCPCS modifier CA is defined as a procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission or transfer to another hospital.
• Section 160.1 Critical Care Services revised, and new Section 160.2 Trauma Activation Services added, to clarify billing requirements related to Trauma Team Activation (including how 99291 maps and when trauma activation is billed with critical care under the OPPS rules restated in the manual excerpt).

Read the redlined manual language in the CR attachment before changing local outpatient ED / trauma charge-capture tip sheets.

Skin substitutes and related October lines

The same CR revises several skin-substitute HCPCS long descriptors retroactive to April 1, 2026 (Table 14; add-on parenthetical language) and creates new skin-substitute HCPCS effective October 1, 2026 (Table 15; SI S1 with APC 6001 or 6002, or SI N packaged). Table 16 updates non-opioid pain-relief device descriptor language for HCPCS C9812. Those are Attachment A pulls, not invented code lists.

What this is not

• Not a rewrite of the live October 2026 HCPCS G0685 ASD algorithm assessment tip. G0685 appears here only as one OPPS quarterly line item.
• Not the companion I/OCE specifications CR itself (R13979CP / CR 14594). Use that PDF when you need Version 27.3 edit logic detail.
• Not an NCCI PTP or add-on code quarterly file. NCCI items (including R13946CP / R13948CP) remain on HOLD for this desk.
• Not a claim that a new HCPCS or CPT code is covered. CR 14589 reminds readers that a code and OPPS payment rate do not imply Medicare coverage; MACs still apply coverage rules.
• Not a full reprint of Attachment A Tables 1-16. Pull the CMS PDF and October Addendum B for descriptors, SIs, and APCs.

Look up outpatient CPT and HCPCS descriptors in the encoder after you confirm the October OPPS Addendum B and I/OCE loads. Browse companion CMS Watch items on /news.