This year's Federal Fiscal Year (FFY) final rules are already revealing significant reimbursement, quality reporting, and coding changes that will affect providers across care settings. From payment rate updates and reporting requirements to MS-DRG revisions and ICD-10 code changes, the following highlights represent some of the most notable developments healthcare compliance, coding, and revenue cycle professionals should be evaluating now.
Below are key highlights of recent final rule releases.
Inpatient Psychiatric Facility Prospective Payment System Final Rule (CMS-1847-F) released July 29th.
- 2.3% increase in payment rates.
- Finalizing but deferring the proposed outlier payment cap on high-cost facilities to 2028 – cap at 20% of IPF’s PPS reimbursement.
- Standardizing IPF patient assessment instrument (IPF-PAI) submissions, providing the option to either use the CMS web application (Patient Assessment Reporting Interoperability Tool (PARIT) OR submission of IPF-PAI data via the CMS API.
Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1843-F) released July 29th.
- 2.4% increase in payment rates.
- Requiring submission of Minimum Data Set (MDS) on All SNF residents, regardless of payer.
- Request for Information on updates to Patient Driven Payment Model (PDPM) for future rulemaking.
Inpatient Rehabilitation Facilities Prospective Payment System Final Rule (CMS-1845-F) released July 30th.
- 2.3% increase in payment rates.
- All therapies must be initiated within 36 hours of admission.
- Interdisciplinary Team meeting must be completed on or before the 4th day of admission and conducted weekly (7 days)
Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) released July 30th.
- 2.3% increase in payment rates.
- Mandate of the hospice election statement addendum for all electing hospice benefits providing transparency into non-covered items, services or drugs.
Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1849-F)
- 2.3% increase in payment rates for both payment systems.
- Strengthening discrimination protections for Graduate Medical Education, Nursing & Allied Health programs.
- Adoption of a Hospital 30-Day all-cause, risk-standardized readmission rate following Sepsis hospitalization measure for use beginning in FY2030.
- Revisions to the Transforming Episode Accountability Model (TEAM) and expansion of the Comprehensive Care for Joint Replacement (CJR), model to the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model effective in 2028.
- Approval of 19 new technologies for New Technology Add-on Payment (NTAP) status, 41 continued NTAP technologies and 13 discontinued.
- Various code reassignments ICD-10 codes to MS-DRGs
- Deletion of 18 MS-DRGs
- 258, 259, 260, 261 and 262 with creation of 2 MS-DRGs with two-way severity level split for Cardiac Pacemaker Revision or Device Replacement
- 264 with addition of 2 MS-DRGs (361 and 362) Other Circulatory System O.R. Procedures
- 466, 467, 468 Revision of Hip/Knee Replacements
- 485, 486, 487 Knee Procedures with Infection
- 736, 737, 738, 739, 740, 741 Uterine and Adnexa Procedures for Malignancy
- Addition of 14 MS-DRGs
- 210 and 211 Cardiac Pacemaker Revision or Device Replacement
- 361 and 362 Other Circulatory System O.R. Procedures
- 400 Knee Procedures with Principal Diagnosis of Infection
- 403 Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection with MCC or Insertion of Antibiotic-eluting Bone Void Fille
- 404 Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection without MCC
- 449 Revision of Hip or Knee Prosthesis
- 523, 524, and 525 Extensive or Complex Spinal Fusion Procedures Except Cervical
- 731, 732, 733 Uterine and Adnexa Procedures for Malignancy
- Modification of 22 MS-DRG Descriptions
ICD-10 Coding Updates Effective October 1st
Effective October 1, 2026, ICD-10-CM will adopt 190 new codes with 4 code revisions and 30 deletions. The highest volume of code additions relates to Obstetrics, Toxic Effects and Medical/ Surgical sections.
Changes to ICD-10-PCS encompass 101 Additions, 38 Deletions and 3 Revisions. The largest percentage of changes in Extracorporeal or Systemic Assistance and Performance, New Technology, Physical Rehabilitation & Diagnostic Audiology and Medical and Surgical sections.
