2026 HCPCS Level II Changes: What the October Update Means for Providers and Billing Teams

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The Centers for Medicare & Medicaid Services (CMS) has released its October 2026 update to the Healthcare Common Procedure Coding System (HCPCS) Level II code set, with the changes taking effect October 1, 2026.

The quarterly update includes 45 new HCPCS Level II codes, 15 deleted codes, 11 long-descriptor revisions, five payment changes, and one administrative-field change. The official October 2026 Alpha-Numeric HCPCS file is now available through CMS.

While HCPCS updates can appear highly technical, their operational impact is anything but. Changes to codes, descriptors, units of measure, and payment-related fields can affect everything from charge capture and claim edits to coding workflows and reimbursement.

For practices and billing organizations, the October update is therefore less about memorizing dozens of new codes and more about making sure the right changes are reflected across the revenue cycle before the new codes become effective.

What Is Changing in the October 2026 Update?

HCPCS Level II codes are primarily used to identify products, supplies, services, and certain drugs that are not represented by the American Medical Association's CPT® code set.

The October 2026 update touches several areas of the code set, including wound-care products, infusion equipment and supplies, orthotic devices, breast prostheses, drugs and biological products, and other specialized services.

The headline numbers are:

• 45 new codes
• 15 deleted codes
• 11 long-descriptor changes
• 5 payment changes
• 1 administrative-field change

CMS has increasingly moved toward more frequent HCPCS Level II coding updates, allowing coding changes to be incorporated throughout the year rather than waiting for a single annual update.

That shorter update cycle makes timely implementation particularly important for organizations managing large or diverse code inventories.

New Codes Reflect a Broadening Range of Products and Services

One of the most visible aspects of the October update is the addition of new codes for products and services that previously required other coding approaches.

Wound Care Gets Several New Codes

A notable portion of the new codes involves wound-care products and advanced wound-care materials.

Among the additions are:

• A2046 – DermiSphere hDRT, reported per square centimeter
• A2047 – LacertaMatrix, reported per square centimeter
• A2048 – PuraPly MZ, reported per milligram
• A2049 – Theracor, reported per square centimeter
• A2050 – Fibrillar collagen wound dressing, reported per milligram
• Q4207 – Carbon Life, reported per square centimeter
• Q4223 – DermaBind SL Optic, reported per square centimeter
• Q4243 – AmchoMatrix, reported per square centimeter

Several of these are add-on codes, meaning their reporting requirements must be understood in relation to the associated primary service. Other codes use a product-specific unit such as milligrams or square centimeters.

For wound-care providers, this is an important distinction. A code becoming available does not simply mean that it should be added to the chargemaster and used immediately. The unit of service, documentation requirements, applicable primary procedure, payer policy, and coverage rules still need to be evaluated.

That is especially relevant for practices where advanced wound products represent a significant portion of their supply-related charges.

Infusion Equipment and Supplies

The update also introduces codes related to specialized infusion equipment.

A4228 identifies supplies for the maintenance of a non-insulin, device-drug combination infusion catheter, reported per week. E0788 identifies an ambulatory infusion pump associated with a specific device-drug combination.

These changes illustrate an important feature of HCPCS Level II coding: a new code can represent not only a clinical service, but also the equipment, supplies, or products required to deliver that service.

For billing teams, that means code updates need to be reviewed alongside existing supply, DME, and equipment workflows rather than treated as isolated coding-table changes.

Orthotics and Prosthetics

The October update also adds new orthotic coding options.

L1330 describes a thoracic orthosis used for sternal and/or sternocostal compression, while L1972 describes a prefabricated ankle-foot orthosis with an ankle joint.

At the same time, CMS is revising the descriptor for L1971 to distinguish a prefabricated ankle-foot orthosis that has been customized to fit a specific patient.

That distinction matters because the revised language more clearly separates an off-the-shelf product from one that has been modified or customized by an individual with the appropriate expertise.

Descriptor Changes Can Be Just as Important as New Codes

A common implementation mistake is to focus only on newly created codes.

The October update includes 11 long-descriptor changes, and some of these revisions change how existing codes should be interpreted.

One example involves breast prostheses. CMS is revising L8030 and L8031 to clarify that the codes apply to the applicable breast prosthesis categories "any type." L8035 is similarly revised to clarify that it includes any type of custom breast prosthesis within the descriptor.

There is no new code number to flag in these situations. The code already exists.

The change is in the definition of what the code represents.

That makes descriptor revisions particularly important during coding-system maintenance. A team that updates only its list of new and deleted codes could easily miss a change that affects an existing code's application.

Deleted Codes Require Attention Too

The October update also removes 15 codes from the active code set.

Among the deleted codes are several drug-related codes, including J0640, J1941, J1953, J7517, J7519, J9181, J9190, and J9352, as well as L8696, which is being discontinued in connection with the new L8697 code.

For billing operations, deleted codes deserve the same attention as new ones.

CMS guidance indicates that discontinued HCPCS codes do not receive a general three-month billing grace period. Claims for services furnished on or after the effective date therefore need to use the applicable active code rather than relying on a recently discontinued code.

That makes it important to identify deleted codes before the October 1 date of service and determine whether a replacement code or revised coding approach applies.

Drug Coding Changes Add Another Layer of Review

The October update also includes changes within the J-code and other drug-related portions of HCPCS Level II.

New codes include products such as eplontersen, trabectedin, pivekimab sunirine-pvzy, leucovorin calcium products, and other drugs and biologicals. At the same time, several existing drug codes are being discontinued or replaced.

These changes are particularly relevant to organizations handling physician-administered drugs, hospital outpatient services, oncology, specialty medications, and other services where HCPCS coding is closely connected to reimbursement.

It is also important to distinguish code creation from coverage and payment. The presence of a code does not, by itself, establish that a service or product is covered by Medicare or another payer. Coverage, pricing, and billing requirements may depend on the applicable payer, contractor, benefit category, and other policies.

The Bigger Operational Issue: Updating More Than the Code Set

For revenue cycle teams, the real challenge begins after the CMS file is downloaded.

A HCPCS change can flow through multiple systems and processes, including:

• Encoder and coding software
• EHR and practice-management systems
• Charge masters
• Fee schedules
• DMEPOS billing workflows
• Drug and supply databases
• Claim-edit systems
• Payer-specific billing rules
• Prior authorization workflows
• Internal coding references
• Denial-management workflows

Updating the code table without updating the surrounding workflows can create downstream inconsistencies.

For example, a newly introduced code may have a different unit of measure than the code previously used for a similar product. A deleted code may remain active in a practice-management system. A descriptor change may not be reflected in an internal coding reference. Or a new code may be technically valid but subject to payer-specific coverage or documentation requirements.

In each case, the problem is not necessarily the code itself. It is the disconnect between the code update and the revenue cycle processes built around it.

Bristol's Perspective

At Bristol Healthcare, we view quarterly coding updates as revenue-cycle events rather than simply coding events.

The October 2026 HCPCS changes demonstrate why. New codes can create more precise ways to report products and services, but they also introduce new opportunities for miscoding, incorrect units, outdated charge-master entries, and claim edits if implementation is rushed.

A practical approach is to treat the update as a short implementation cycle:

1. Identify the changes.

Separate new, deleted, revised, and payment-related codes and determine which ones are relevant to the specialties and services being billed.

2. Map the operational impact.

Review affected charge codes, fee schedules, coding references, authorization workflows, and payer-specific requirements.

3. Validate units and descriptors.

Pay particular attention to codes reported by milligram, square centimeter, week, month, or other defined units.

4. Review replacement pathways.

For deleted codes, determine whether CMS has introduced a replacement code or whether another coding approach is required.

5. Test before submission.

Run sample claims or internal validation checks to make sure the updated codes are flowing correctly through the billing system.

6. Monitor the first claims.

The first few weeks after implementation can reveal issues that were not apparent during the initial system update, particularly through claim rejections, payer edits, and denials.

This process is especially important for billing organizations supporting multiple specialties. A code that is irrelevant to one client may be critical to another, making a blanket update less effective than a specialty- and client-specific review.

Preparing for October 1

The October 2026 HCPCS Level II update is not simply a list of 45 new codes. It represents a combination of additions, deletions, descriptor revisions, payment changes, and administrative updates that can affect different parts of the billing workflow.

CMS has made the official October 2026 Alpha-Numeric HCPCS file available through its HCPCS Quarterly Update page, providing the underlying source that organizations should use when updating their coding systems.

For providers and revenue cycle teams, the priority should be straightforward: identify the codes that affect your services, update the systems and workflows that depend on them, validate the changes, and monitor claims after implementation.

A quarterly code update may look like a technical maintenance task. In practice, getting those details right can help prevent avoidable coding errors from becoming avoidable revenue-cycle problems.