CMS Adds 10 New Procedure Codes to October 2026 ASC Payment System: A Coding & Billing Guide

On October 8, 2026, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 13983 (Change Request 14634), outlining the highly anticipated October 2026 update to the Ambulatory Surgical Center (ASC) Payment System. Effective October 1, 2026, and implemented by contractors on October 5, this update brings a wave of changes for medical coding, billing, and revenue cycle professionals.

At the forefront of this update is the addition of 10 new Category III CPT codes, including a highly lucrative reimbursement rate for permanent carotid artery filter placement, along with critical updates to HCPCS pass-through drug codes and skin substitutes.

Here is a breakdown of the most critical changes and how your facility can avoid costly claim denials.

The Heavy Hitter: Carotid Artery Filter Placement (CPT 1091T)

The most significant addition to the ASC covered procedures list is CPT code 1091T (Placement of permanent common carotid artery filter, percutaneous, bilateral, including ultrasound guidance, when performed).

This new device-intensive code carries a staggering national payment rate of $11,912.65 in the ASC setting.

Coding Action Item: CPT 1091T officially replaces HCPCS code C8010, which CMS has deleted. C8010 was previously used to describe the Category B Investigational Device Exemption (IDE) clinical study associated with Javelin Medical's carotid implants. Because 1091T describes the exact same bilateral procedure, billers must update their chargemasters immediately to swap out C8010 for 1091T to prevent rejected claims.
Diagnosis Coding Context: To establish medical necessity for this procedure, precise ICD-10-CM coding is paramount. Coders should look to specific atherosclerosis and stenosis codes, such as ICD-10-CM code I65.23 (Occlusion and stenosis of bilateral carotid arteries). As the industry slowly prepares for the eventual transition to ICD-11, ensuring high-specificity documentation for cerebrovascular diseases now will make mapping to future ICD-11 stroke and stenosis categories much smoother.

Orthopedics and Pain Management Additions

Beyond vascular procedures, the October 2026 ASC update introduces two new device-intensive codes for knee cartilage scaffold implants:

CPT 1092T (open procedures) – Carries a national payment rate of $4,682.29.
CPT 1093T (arthroscopic procedures) – Carries a national payment rate of $2,084.06.

Additionally, CMS expanded the descriptor for the non-opioid pain relief code HCPCS C9812 (Echogenic nerve block needles, non-opioid medical device) to explicitly include Stimuplex nerve block needles. The payment for this is capped at $1,997.16 and is uniquely effective retroactively to April 30, 2026.

Drugs, Biologicals, and Skin Substitutes

The drug and biological section of the ASC fee schedule mirrors the hospital outpatient update. Medical billing teams must note the following changes to ensure clean claims:

12 new HCPCS codes for drugs and biologicals have been granted pass-through status.
10 drug codes were officially deleted as of September 30, 2026.
8 new skin substitute codes were added to the payment system.

Revenue Cycle Best Practices for Q4 2026

Because ASCs are paid per case, a chargemaster that is even a week behind can cost a facility tens of thousands of dollars. If claims for permanent carotid artery filter placement are submitted with the deleted HCPCS code C8010 instead of the newly minted CPT code 1091T, the resulting denials will severely disrupt cash flow.

Action Plan for Billers and Coders:

Download the October Addenda: Confirm your IT vendor or clearinghouse has successfully installed the October 2026 ASC fee schedule, drug file, code pair file, and payment indicator file.
Audit Your Chargemaster: Manually verify that C8010 has been deactivated and 1091T, 1092T, and 1093T have been added with their respective device-intensive status indicators.
Educate Providers: Remind physicians documenting carotid artery filter placements to specify laterality and use high-value diagnosis codes like ICD-10-CM code I65.23 to support the new CPT 1091T claims.

Staying ahead of CMS quarterly updates is the cornerstone of a healthy revenue cycle. By implementing these October 2026 ASC Payment System changes promptly, your facility can ensure compliance and capture full reimbursement for high-acuity procedures.