Modifier and HCPCS Changes for July 2026 - JE Part B
Modifier and HCPCS Changes for July 2026
The following new and deleted National Level II modifiers and Healthcare Common Procedure Coding System (HCPCS) are effective for dates of service on/after July 1, 2026.
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.
Note: The inclusion of modifiers or codes on this web page do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.
New Modifiers
| MODIFIER | DESCRIPTION |
|---|---|
| AC | Microlyte painguard, per square centimeter |
New Codes
| HCPCS | DESCRIPTION |
|---|---|
| A9574 | Injection, ferumoxytol, 1 mg |
| C1609 | Vertebral device, motion-preserving, with screw fixation |
| C8014 | Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, including use of a suction enabled ureteral access sheath, with irrigation (if performed) |
| C9310 | Injection, leucovorin calcium (avyxa), 1 mg |
| G0574 | Management of new patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services mush be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided) |
| G0575 | Management of established patient with dementia residing in an eligible residential care community, for use only in a medicare-approved cmmi model (services mush be furnished within a patient's eligible residential care community, including assisted living facilities, board and care homes, or other qualifying residential settings where dementia care services are provided) |
| G0669 | Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); initial 12-month period; per month |
| G0670 | Outcome-aligned payment (oap) for technology-enabled chronic care management of early cardio-kidney-metabolic (eckm) conditions (hypertension, or two or more of: dyslipidemia, obesity/overweight with central obesity marker, prediabetes); follow-on 12-month period; per month |
| G0671 | Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); initial 12-month period; per month |
| G0672 | Outcome-aligned payment (oap) for technology-enabled chronic care management of cardio-kidney-metabolic (ckm) conditions (one or more of: diabetes mellitus, chronic kidney disease stage 3a or 3b, atherosclerotic cardiovascular disease); follow-on 12-month period; per month |
| G0673 | Outcome-aligned payment (oap) for technology-enabled chronic care management of musculoskeletal (msk) conditions (chronic musculoskeletal pain); initial 12-month treatment period; per month |
| G0674 | Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); initial 12-month period; per month |
| G0675 | Outcome-aligned payment (oap) for technology-enabled chronic care management of behavioral health (bh) conditions (one or more of: depression, anxiety); follow-on 12-month period; per month |
| G0676 | Standard co-management service payment for documented review of clinical updates from access participant managing cardio-kidney-metabolic conditions (early cardio-kidney-metabolic [eckm] or cardio-kidney-metabolic [ckm] track); per review |
| G0677 | Standard co-management service payment for documented review of clinical updates from access participant managing musculoskeletal (msk) conditions; per review |
| G0678 | Standard Co-Management service payment for documented review of clinical updates from ACCESS Participant managing behavioral health (BH) conditions (depression, anxiety); per review |
| J0528 | Injection, fosfomycin disodium, 20 mg |
| J1289 | Injection, narsoplimab-wuug, 1 mg |
| J1577 | Injection, immune globulin (qivigy), 100 mg |
| J2361 | Injection, depemokimab-ulaa, 1 mg |
| J2374 | Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 ml |
| J2789 | Riboflavin 5'-phosphate, ophthalmic solution (epioxahd/epioxa), up to 2 ml |
| J3386 | Injection, etuvetidigene autotemcel, per treatment |
| J3405 | Injection, onasemnogene abeparvovec-brve, per treatment |
| J7176 | Injection, human fibrinogen - chmt (fesilty), 1 mg |
| J9053 | Injection, belantamab mafodotin-blmf, 0.1 mg |
| J9062 | Injection, amivantamab 5 mg and hyaluronidase-lpuj |
| J9232 | Injection, docetaxel (hospira), not therapeutically equivalent to j9171, 1 mg |
| M0231 | Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, first dose |
| M0232 | Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, second dose |
| Q0234 | Injection, tocilizumab-bavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, 1 mg |
| Q5164 | Injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg |
| Q5165 | Injection, denosumab-mobz (oziltus), biosimilar, 1 mg |
| Q5166 | Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg |
| Q5167 | Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg |
| Q5168 | Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mg |
| Q5169 | Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg |
| Q5170 | Injection, aflibercept-boav (eydenzelt), biosimilar, 1 mg |
| Q5171 | Injection, denosumab-mobz (boncresa), biosimilar, 1 mg |
| 0631U | Oncology (solid tumor), dna, sequence analysis of 15 genes including brca1 and brca2 for identification of clonal hematopoiesis, blood, reported as tumor-derived or nontumor-derived |
| 0632U | Red blood cell antigen (fetal rhd gene analysis), multiplex polymerase chain reaction (pcr) and next-generation sequencing (ngs) of circulating cell-free dna (cfdna), plasma from pregnant individuals known to be rhd negative, reported as detected or not detected |
| 0633U | Obstetrics (single-gene noninvasive prenatal test), cell-free dna (cfdna), next-generation sequencing (ngs) analysis of 1 or more targets (eg, cftr, smn1, hbb, hba1, hba2) to identify paternally inherited pathogenic variants and to determine fetal inheritance of maternal mutation, using maternal blood sample, algorithm reported as a fetal risk score |
| 0634U | Oncology (breast cancer), cell-free dna (cfdna), evaluation of 11 esr1 variants (e380q, s463p, l536r, y537c, y537n, y537s, d538g, v422del, l536h, l536p, y537d) using droplet digital pcr (ddpcr), plasma, reported as positive or negative |
| 0635U | Autoimmune (atopic dermatitis), mrna, next-generation sequencing (ngs), gene expression profiling of 487 genes, noninvasive skin-surface scraping, algorithm reported as likelihood of response to therapy |
| 0636U | Babesia (babesiosis), antibody detection of 20 recombinant protein groups, by immunoassay, igg |
| 0637U | Babesia (babesiosis), antibody detection of 20 recombinant protein groups, by immunoassay, igm |
| 0638U | Bartonella (bartonellosis), antibody detection of 32 recombinant protein groups, by immunoassay, igg |
| 0639U | Bartonella (bartonellosis), antibody detection of 32 recombinant protein groups, by immunoassay, igm |
| 0640U | Oncology (leptomeningeal metastases), tumor cell selection, identification, detection and enumeration based on differential cd318(cdcp1), susd2, cd340(erbb2/her2), hgfr/cmet, folr1, egfr, n cadherin, muc1, epcam, and trop2 antibody biomarkers, cerebrospinal fluid, reported as detection and quantification of tumor cells |
| 0641U | Oncology (minimal residual disease [mrd]), tumor dna, next-generation sequencing (ngs), using formalin-fixed paraffin-embedded (ffpe) tissue and blood samples, initial (baseline) assessment |
| 0642U | Oncology (minimal residual disease [mrd]), tumor dna, next-generation sequencing (ngs), whole blood, comparison to previously performed analyses, reported as trend in circulating tumor dna (ctdna) level |
| 0643U | Oncology (genitourinary cancer), cell-free circulating tumor dna (ctdna), 200 genes, next-generation sequencing (ngs), interrogation for single-nucleotide variants (snvs), insertions/deletions, gene rearrangements, copy number alterations, and tumor mutation burden, using urine, identify and report mutations with clinical actionability |
| 0644U | Oncology (leukemia), minimal residual disease (mrd) detection for rearrangements, blood or bone marrow, personalized assay design and baseline quantification |
| 0645U | Oncology (leukemia), minimal residual disease (mrd) detection for rearrangements, based on digital pcr, blood or bone marrow, reported as not detected or detected with estimated abundance |
| 0646U | Oncology (molecular residual disease), whole genome sequence analysis, cell-free dna, whole blood, and formalin-fixed paraffin-embedded (ffpe) tumor tissue dna, baseline assessment |
| 0647U | Oncology (molecular residual disease), whole genome sequence analysis, cell-free dna (cfdna), whole blood, assessment utilizing patient-specific tumor information, reported as negative or percent circulating tumor dna (ctdna) |
| 0648U | Oncology (solid tumor), targeted genomic sequencing analysis, to detect deletions, insertions, and substitutions in 42 genes, copy number amplifications in 10 genes, and fusions and splice variants in 18 driver genes from dna and rna extracted from formalin-fixed paraffin-embedded (ffpe) tissue |
| 0649U | Neurology (alzheimer disease), dna, targeted next-generation sequencing (ngs) of ad-1 and ad-2 target regions, whole blood, prognostic algorithmic analysis, reported as categorization of cognitive status |
| 0650U | Drug metabolism (adverse drug reactions and drug response), genotyping of 9 genes (ie, cyp2d6, cyp2c19, g6pd, slco1b1, hla-b*58:01, nat2, cyp2c9, vkorc1, abcg2), reported as metabolizer status and transporter function |
| 0651U | Oncology (hereditary cancer), genomic dna, 55 hereditary cancer pre-dispositioned genes, next-generation sequencing (ngs) and digital multiplex ligation-dependent probe amplification for variants, small indels (<40 base pairs), using saliva, whole blood or nail clipping, interpretive clinical report with variant classification |
| 0652U | Drug metabolism (adverse drug reactions), dna analysis of 13 genes by targeted genotyping, using saliva or buccal swab, reported as diplotype and metabolizer status |
| 0653U | Nephrology (inherited kidney disorders), dna, analysis of approximately 700 genes associated with inherited kidney diseases by exome sequencing, using whole blood, saliva, or nail clipping, reported as an interpretive clinical report classifying pathogenic and likely pathogenic variants |
| 0654U | Inborn error of metabolism (primary mitochondrial disease), mitochondrial analysis of 1 enzyme complex by western blot analysis, using cultured skin fibroblasts, diagnostic qualitative result |
| 0655U | Inborn error of metabolism (primary mitochondrial disease), mitochondrial analysis of 1 enzyme complex by spectrophotometric kinetic assay, using cultured skin fibroblasts, diagnostic quantitative result |
| 0656U | Inborn error of metabolism (primary mitochondrial disease), mitochondrial analysis of 1 enzyme complex by radioactive activity assay, using cultured skin fibroblasts, diagnostic quantitative result |
| 0657U | Rare diseases (constitutional/heritable disorders), rapid whole genome sequence analysis of comparator nuclear and mitochondrial dna by next-generation sequencing (ngs), using blood or buccal sample, relevant variants reported with proband results |
| 0658U | Rare diseases (constitutional/heritable disorders), rapid whole genome sequence analysis of nuclear and mitochondrial dna by next-generation sequencing (ngs) for single-nucleotide variants (snvs), insertions/deletions, copy number variants, uniparental disomy, and repeat expansions, using blood or buccal sample, identification and categorization of genetic variants |
| 0659U | Rare diseases (constitutional/heritable disorders), ultrarapid whole genome sequence analysis of nuclear and mitochondrial dna by next-generation sequencing (ngs) for single-nucleotide variants (snvs), insertions/deletions, copy number variants, uniparental disomy, and repeat expansions, using blood or buccal sample, identification and categorization of genetic variants |
| 90616 | Influenza virus vaccine, trivalent (tirv), mrna, 37.5 mcg/0.38 ml dosage, for intramuscular use |
| 90639 | Influenza virus vaccine, quadrivalent (qirv), mrna; 50 mcg/0.5 ml dosage, for intramuscular use |
| 1026T | Transvaginal laser photobiomodulation therapy of pelvis, provided by a physician or other qualified health care professional |
| 1027T | Percutaneous insertion or replacement of neurostimulation catheter via left subclavian or left jugular vein into the superior vena cava, with verification of capture of phrenic nerves, mapping and programming, and delivery of transvenous phrenic neurostimulation therapy in ventilated patients, with repositioning when performed, including imaging guidance |
| 1028T | Mapping and programming of neurostimulation catheter with delivery of transvenous phrenic neurostimulation therapy in ventilated patients, with repositioning and verification of left phrenic nerve capture, per session |
| 1029T | Mapping and programming of neurostimulation catheter with delivery of transvenous phrenic neurostimulation therapy in ventilated patients, without catheter repositioning, per session |
| 1030T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]), cumulative time for up to 30 days; initial 30 minutes |
| 1031T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]), cumulative time for up to 30 days; each additional 30 minutes (list separately in addition to code for primary procedure) |
| 1032T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]) and digital simulation, cumulative time for up to 30 days; initial 60 minutes |
| 1033T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]) and digital simulation, cumulative time for up to 30 days; each additional 30 minutes (list separately in addition to code for primary procedure) |
| 1034T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]), digital simulation, and computational analyses (eg, computational fluid dynamics, finite element analysis), cumulative time for up to 30 days; initial 90 minutes |
| 1035T | Creation of digital 3d model from surface mesh files of patient-specific anatomy (eg, final anatomic representation [far]), digital simulation, and computational analyses (eg, computational fluid dynamics, finite element analysis), cumulative time for up to 30 days; each additional 30 minutes (list separately in addition to code for primary procedure) |
| 1036T | Noninvasive hemodynamic assessment with pulmonary pressures and ejection fraction when performed, including passive acquisition of acoustic and electrical signals, augmentative algorithmic analysis, and generation of a clinical report with review, interpretation, and clinical integration by a physician or other qualified health care professional |
| 1037T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant pancreatic tissue, including imaging guidance |
| 1038T | Autologous muscle cell therapy, injection(s) of muscle progenitor cells into the tongue, including esophagoscopy, when performed |
| 1039T | Connectomic analysis of previously performed multi-modal brain magnetic resonance imaging (mri) requiring physician or other qualified health care professional (qhp) analysis of software- and physician-generated structural and functional maps for integration of cortical grey matter correlation based on restingstate functional mri and mapping of white matter connectivity based on diffusionweighted mri relative to brain regions, with physician or other qhp interpretation and report |
| 1040T | Bronchoscopy, flexible, with bronchial cryotherapy, 1 lung, including trachea, when performed |
| 1041T | Augmentative algorithmic analysis of encephalographic waveforms to identify the source and propagation of epileptiform activity, including artifact reduction with analysis of 3d localization of spike sources throughout the examination, 3d animations over time of high-amplitude event locations, high-frequency activity locations, and temporal relationships among locations, with interpretation and report by physician or other qualified health care professional, related to a previously performed electroencephalogram |
| 1042T | Implantation of absorbable urologic scaffold for prostatic urethra restoration of reconstructed bladder neck and urethral anastomosis (list separately in addition to code for primary procedure) |
| 1043T | Quantitative magnetic resonance, without imaging, for analysis of liver tissue, including assessment of 1 or more parameters (eg, proton density fat fraction [pdff], water diffusion, t1-water relaxation time), with automatically generated report |
| 1044T | Harvest of full-thickness skin for autologous heterogeneous skin-construct graft, including direct closure of donor site; first 5 sq cm or less |
| 1045T | Harvest of full-thickness skin for autologous heterogeneous skin-construct graft, including direct closure of donor site; each additional 5 sq cm, or part thereof (list separately in addition to code for primary procedure) |
| 1046T | Autologous heterogeneous skin-construct graft application, trunk, arms, legs; first 50 sq cm or less, or 0.5% of body area of infants and children |
| 1047T | Autologous heterogeneous skin-construct graft application, trunk, arms, legs; each additional 50 sq cm, or each additional 0.5% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
| 1048T | Autologous heterogeneous skin-construct graft application, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 50 sq cm or less, or 0.5% of body area of infants and children |
| 1049T | Autologous heterogeneous skin-construct graft application, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 50 sq cm, or each additional 0.5% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
| 1050T | Insertion, subcutaneous heart failure decompensation monitor, containing sensors that measure, at a minimum, heart rate, impedance, respiration rate, physical activity, heart sounds |
| 1051T | Removal of subcutaneous heart failure decompensation monitor |
| 1052T | Interrogation device evaluation(s), (in person or remote) up to 30 days, insertable subcutaneous heart failure decompensation monitor, analysis of physiologic parameters, including, at a minimum, heart rate, impedance, respiration rate, physical activity, heart sounds, with generation of a report, review and interpretation by a physician or other qualified health care professional |
| 1053T | Programming device evaluation (in person or remote) of subcutaneous heart failure decompensation monitor, with analysis of physiologic parameters, including, at a minimum, heart rate, impedance, respiration rate, physical activity, heart sounds, with generation of a report and review and interpretation by a physician or other qualified health care professional |
| J9037 | Injection, belantamab mafodontin-blmf, 0.5 mg |
Deleted Codes
| HCPCS | DESCRIPTION |
|---|---|
| C9309 | Injection, onasemnogene abeparvovec-brve, per treatment |
| 0029U | Gene analysis of targeted sequences for adverse drug reactions and drug response |
| 0031U | Gene analysis (cytochrome P450 family 1, subfamily A, member 2) for common variants |
| 0423U | Genomic analysis panel of 26 genes from cheek swab, report including metabolizer status and risk of drug toxicity by psychiatric condition |
| 0577U | Analysis of proteins reported as likelihood of malignancy in ovarian cancer |
Source
Transmittal 13622, CR 14328 dated February 5, 2026
Last Updated Jun 17 , 2026
