CMS CR 14574: Medicare payer-only claim codes update takes effect September 28, 2026

CMS issued Change Request 14574 on August 26, 2026, as Transmittal 13904 (Pub 100-04 Medicare Claims Processing Manual). The subject is updates to chapter one to include newly created and utilized payer-only codes.

EFFECTIVE DATE: September 28, 2026 (date of service unless otherwise specified). IMPLEMENTATION DATE: September 28, 2026.

This is a claims-processing manual update for payer-assigned codes, not a CMS-HCC map change and not the live MSP CARC processing CR 14553 story.

What CR 14574 changes

The CR revises two sections of Pub 100-04 chapter 1:

Business requirement 14574.1 tells Medicare contractors to be aware of the corrections to section 190 and make any necessary file updates. Business requirement 14574.2 tells contractors to recognize the new Treasury URL `https://fiscal.treasury.gov/payments-from-government/prompt-payment/rates` for Prompt Payment interest rates.

The CR states: This CR contains no policy changes. Provider education in the CR is marked None. The desk value is still real: section 190 restates which codes Medicare assigns systematically, and it tells providers not to put those codes on the claim.

Providers shall not submit payer-only codes

Section 190 opens with the operational rule billing staff need on the desk:

> This section contains the listing of payer codes designated by the National Uniform Billing Committee to be assigned by payers only. Providers shall not submit these codes on their claim forms. The definitions indicating Medicare’s usage for these systematically assigned codes are indicated next to each code value.

Payer-only codes are for Medicare systems and contractors. If a condition code, occurrence code, value code, or modifier is on the payer-only list, your claim form is not the place to invent or copy it from a remittance. Leave those fields for the payer’s systematic assignment.

What the §190 list covers

The revised section 190 groups payer-only values into the familiar institutional-claim families. The CR prints Medicare’s usage next to each code value. Representative families include:

This page quotes values the CR prints. It does not invent NUBC long definitions beyond the CR text, and it does not mark which individual values are brand-new versus restated. The subject line says the update includes newly created and utilized payer-only codes; the body reprints the full section 190 inventory with the September 28, 2026 revision stamp.

Treasury interest-rate URL also moves

Alongside the payer-only list, CR 14574 revises §80.2.2 on interest for clean non-PIP claims not paid timely. Contractors must recognize the new Treasury Prompt Payment rates page at `https://fiscal.treasury.gov/payments-from-government/prompt-payment/rates`. Providers may use that page for the correct six-month interest rate. Medicare contractors shall include notification of any Treasury rate change in routine educational materials and/or their websites.

Interest still uses the formula the manual prints: payment amount × rate × days ÷ 365 (366 in a leap year). That formula is unchanged; only the URL contractors and providers use to look up the rate is updated in this CR.

What this is not

It is not a CMS-HCC, V28, or RADV documentation change. Payer-only claim codes do not rewrite risk-adjustment diagnosis rules. If the question is risk scores, use ICD-10 to HCC for the model year you are coding.

It is not the live hospice G0679 telehealth face-to-face recertification story. G0679 is a reportable hospice HCPCS for telehealth F2F encounters; payer-only codes are a different Pub 100-04 §190 inventory.

It is not the live MSP CARC processing CR 14553 Part A secondary-claim story.

Look up official procedure and diagnosis descriptors in the encoder or the code book when a returned claim also depends on a code choice. This page stays on the payer-only code rules CMS printed in CR 14574.