CMS Releases 2026 IPPS Proposed Rule for Review and Comments
CMS Releases 2026 IPPS Proposed Rule for Review and Comments
The Centers for Medicare and Medicaid Services (CMS) released the Proposed Rule for the FY 2026 IPPS system for public inspection. The rule will be published in the Federal Register on April 30, 2025. Comments on all the proposals will be accepted until June 10, 2025.
The Proposed Rule draft is over 1,300 pages and includes proposals on a wide range of programs. A fact sheet outlining these programs is available.
Payment Increase and MS-DRG Changes
The rule calls for a 2.4% increase for inpatient hospital payments for fiscal year 2026. The rule also includes updates to Grouper logic for MS-DRGs, recommendations on New Technology payments, and a variety of other adjustments.
The rule proposes the deletion of three MS-DRGs for hypertensive encephalopathy: MS-DRGs 077, 078, and 079.
Seven new MS-DRGs are proposed: MS-DRG 209 for complex aortic arch procedures, MS-DRG 213 for endovascular abdominal aorta and iliac branch procedures, MS-DRGs 359 and 360 for percutaneous coronary atherectomy with intraluminal device, MS-DRG 318 for percutaneous coronary atherectomy without intraluminal device, and MS-DRGs 403 and 404 for hip or knee procedures with principal diagnosis of periprosthetic joint infection.
New ICD-10 Diagnosis and Procedure Codes
The rule also includes tables with proposed ICD-10-CM and ICD-10-PCS code changes. Traditionally, changes to the diagnosis codes remain as presented in the Proposed Rule.
Over 400 new diagnosis codes have been proposed. Many of these involve the addition of the anatomical site of the right, left, and unspecified flank for a wide variety of conditions, such as cellulitis, pain, contusions, blisters, bites, wounds, and other conditions. Highlights of other codes proposed include those for inflammatory breast cancer, Type 2 diabetes in remission, multiple sclerosis phenotypes, thyroid eye disease, neovascular glaucoma, and other diseases and conditions.
There are less than 20 ICD-10-PCS codes listed in the Proposed Rule for implementation on October 1, 2025. But, many additions are anticipated to be included in the Final Rule based on actions taken from the March 2025 Coordination and Maintenance Committee activities.
The Final Rule with all confirmed changes is expected to be released on or before August 1, 2025. YES HIM Consulting will have comprehensive presentations on the diagnosis, procedure, and new technology code updates, as well as the finalized updates to the IPPS system. Stay tuned to the YES Blog for more information on the latest coding updates.
