Joint DME MAC and PDAC Publication
Posted October 1, 2026
The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2026. The tables contain only HCPCS codes applicable to items within Medicare DME MAC jurisdiction. There may be other HCPCS code changes for items under the jurisdiction of other Medicare contractors. Consult those contractors for information regarding HCPCS codes within their areas of responsibility.
All HCPCS code changes are effective for claims with dates of service on or after October 1, 2026.
Code Change Categories
- Added Codes/Modifiers: Identifies newly created codes and modifiers. Listing of a code in the tables does not necessarily indicate coverage. Refer to the applicable Local Coverage Determination for information regarding Medicare reimbursement requirements.
- Discontinued Codes/Deleted Modifiers: Identifies codes and modifiers discontinued or deleted in the new cycle. These codes and modifiers continue to be valid for Medicare claims with dates of service either on or before September 30, 2026. There is no grace period for submission of a discontinued code/modifier for claims with dates of service after its effective end date. If there is a direct crosswalk for a discontinued/deleted code or modifier, the crosswalk code will be displayed in a table.
- Narrative Changes: Identifies changes in the narrative descriptor for an existing code or modifier.
Added Codes
Ankle-Foot/Knee-Ankle-Foot Orthosis
| Code | Narrative |
|---|
| L1972 | ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, WITH OR WITHOUT DORSIFLEXION ASSIST, PREFABRICATED, OFF-THE SHELF |
External Infusion Pumps
| Code | Narrative |
|---|
| A4228 | SUPPLIES FOR MAINTENANCE OF NON-INSULIN, DEVICE-DRUG COMBINATION INFUSION CATHETER, PER WEEK |
| E0788 | AMBULATORY INFUSION PUMP, SPECIFIC DEVICE-DRUG COMBINATION, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY OPERATED, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT |
| J9191 | INJECTION, FLUOROURACIL (AVYXA), 10 MG |
| J9192 | INJECTION, FLUOROURACIL, 10 MG |
Immunosuppressive Drugs
| Code | Narrative |
|---|
| J7524 | MYCOPHENOLATE MOFETIL, ORAL, 5 MG |
| J7529 | MYCOPHENOLATE MOFETIL, FOR SUSPENSION, ORAL, 5 MG |
| J7530 | MYCOPHENOLATE MOFETIL (MYHIBBIN), ORAL SUSPENSION, 5 MG |
| J7531 | PREDNISOLONE SODIUM PHOSPHATE, ORALLY DISINTEGRATING TABLET, 1 MG |
Miscellaneous
| Code | Narrative |
|---|
| A6614 | SUPPLIES AND ACCESSORIES FOR USE WITH AN EXTERNAL OCULAR NEGATIVE PRESSURE PUMP, ANY TYPE, PER MONTH |
| E2403 | EXTERNAL OCULAR NEGATIVE PRESSURE PUMP, ELECTRIC |
| J0643 | INJECTION, LEUCOVORIN CALCIUM, NOT OTHERWISE SPECIFIED, 1 MG |
| J0644 | INJECTION, LEUCOVORIN CALCIUM (AVYXA), 1 MG |
| J0871 | INJECTION, DAPTOMYCIN (ENDO), NOT THERAPEUTICALLY EQUIVALENT TO J0878, 1 MG |
| J1757 | INJECTION, TIVIDENOFUSP ALFA-EKNM, 1 MG |
| J1818 | INJECTION, PEGZILARGINASE-NBLN, 0.05 MG |
| J1946 | INJECTION, FUROSEMIDE (LASIX ONYU), 1 MG |
| J1947 | INJECTION, FUROSEMIDE (FUROSCIX), 1 MG |
| J1957 | INJECTION, LEVETIRACETAM, 5 MG |
| J1958 | INJECTION, LEVETIRACETAM IN SODIUM CHLORIDE, 5 MG |
| J3268 | INJECTION, DELAFLOXACIN, 1 MG |
| J3406 | INJECTION, OMIDUBICEL-ONLV, PER THERAPEUTIC DOSE |
| J7526 | INJECTION, MYCOPHENOLATE MOFETIL, 5 MG |
| J9066 | INJECTION, BENDAMUSTINE HYDROCHLORIDE (AVYXA), 1 MG |
| J9186 | INJECTION, ETOPOSIDE (AVYXA), 1 MG |
| J9187 | INJECTION, ETOPOSIDE, 1 MG |
| J9362 | INJECTION, TRABECTEDIN, 0.01 MG |
| L1330 | THORACIC ORTHOSIS, STERNAL AND/OR STERNOCOSTAL COMPRESSION, MAY INCLUDE ANTERIOR AND/OR POSTERIOR PADS, PANELS, WITH OR WITHOUT FRAME, PREFABRICATED, OFF THE SHELF |
| Q5172 | INJECTION, FILGRASTIM-LAHA (FILKRI), BIOSIMILAR, 1 MICROGRAM |
Discontinued Codes
External Infusion Pumps
| Code | Narrative |
|---|
| J9190 | INJECTION, FLUOROURACIL, 500 MG |
Immunosuppressive Drugs
| Code | Narrative |
|---|
| J7514 | MYCOPHENOLATE MOFETIL (MYHIBBIN), ORAL SUSPENSION, 100 MG |
| J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG |
| J7528 | MYCOPHENOLATE MOFETIL, FOR SUSPENSION, ORAL, 100 MG |
Miscellaneous
| Code | Narrative |
|---|
| J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG |
| J1941 | INJECTION, FUROSEMIDE (FUROSCIX), 20 MG |
| J1953 | INJECTION, LEVETIRACETAM, 10 MG |
| J7519 | INJECTION, MYCOPHENOLATE MOFETIL, 10 MG |
| J9181 | INJECTION, ETOPOSIDE, 10 MG |
| J9352 | INJECTION, TRABECTEDIN, 0.1 MG |
Narrative Changes
Ankle-Foot/Knee-Ankle-Foot Orthosis
| Code | Old Narrative | New Narrative |
|---|
| L1971 | ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, WITH OR WITHOUT DORSIFLEXION ASSIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, WITH OR WITHOUT DORSIFLEXION ASSIST, PREFABRICATED, ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE |
External Breast Prostheses
| Code | Old Narrative | New Narrative |
|---|
| L8030 | BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE | BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE, ANY TYPE |
| L8031 | BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE | BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE, ANY TYPE |
| L8035 | CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL | CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL, ANY TYPE |
Miscellaneous
| Code | Old Narrative | New Narrative |
|---|
| J3300 | INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE, 1 MG | INJECTION, TRIAMCINOLONE ACETONIDE (TRIESENCE), PRESERVATIVE FREE, 1 MG |
| J9033 | INJECTION, BENDAMUSTINE HYDROCHLORIDE, 1 MG | INJECTION, BENDAMUSTINE HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 1 MG |
Refer to the Centers for Medicare and Medicaid Services (CMS) website to download a full listing of HCPCS code additions, revisions, deletions, etc. in an excel file.
For questions about correct coding or products not listed on the DMECS Product Classification List (PCL), contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.
Revision History
| Date | Update |
|---|
| 10/01/2026 | Originally Published |
