FY 2026 IPPS Updates
Instructor
Cari Greenwood, RHIA, CCS, CPC, CICADescription
Get ready for the FY 2026 IPPS updates with HIAlearn’s self-paced course—now available. This course provides a detailed review of IPPS changes that affect coding, including MS-DRG updates, NON-OR to OR DRG reclassifications, Medicare Code Editor revisions, summaries of ICD-10-CM and ICD-10-PCS updates, and New Technology Add-on Payments (NTAP), plus a brief overview of payment changes to frame the coding impact.
With approximately 90 minutes of content and 1.5 AHIMA CEUs, this course is designed for inpatient coders and coding leaders who need to stay current with FY 2026 IPPS updates. By the end, you’ll have the knowledge and context needed to apply these changes confidently and compliantly.
Key Takeaways
- Payment Policy Changes: CMS codifies the Extraordinary Circumstances Exception (ECE) for the IQR, VBP, and HAC Reduction Programs (requests allowed up to 60 days after the event) and removes the COVID-19 exclusion from several IQR measures (e.g., MORT-30-STK, COMP-HIP-KNEE, AMI/HF/PN Excess Days, HWR, HWM).
- MS-DRG Updates: 6 MS-DRGs deleted, 5 created, and 6 retitled, with most shifts in MDC 01 (Nervous System) and MDC 05 (Circulatory). Example changes include new MS-DRG 318 (Percutaneous Coronary Atherectomy) and deletion of DVT MS-DRGs 294–295 with reassignment to 299–301.
- Medicare Code Editor: Revisions implemented to support consistent MS-DRG assignment and compliant reporting.
- NTAP Summary: 54 technologies approved for FY 2026 (27 continued from FY 2025; 5 via the traditional pathway; 22 via the alternative pathway). Accurate documentation and coding are essential to capture add-on payments.
- Readiness Focus: Organizations should review IPPS policy updates alongside ICD-10-CM/PCS changes and MS-DRG remaps to protect reimbursement and ensure regulatory compliance.
FAQs
What payment policy changes did CMS finalize for FY 2026?
CMS codified the Extraordinary Circumstances Exception (ECE) policy for the Hospital IQR, VBP, and HAC Reduction Programs—allowing hospitals to request an exception (and exclude affected data) within 60 days of a qualifying event. CMS also removed the COVID-19 exclusion from several IQR measures, including MORT-30-STK, COMP-HIP-KNEE, AMI/HF/PN Excess Days, HWR, and HWM. These changes aim to standardize reporting and align quality programs with current conditions, effective October 1, 2025.
What are the major MS-DRG changes for FY 2026?
CMS deleted 6 MS-DRGs, created 5 new MS-DRGs, and retitled 6, with most updates in MDC 01 (Nervous System) and MDC 05 (Circulatory System). Examples include the creation of MS-DRG 318 (Percutaneous Coronary Atherectomy without intraluminal device) and deletion of MS-DRGs 294–295 (Deep Vein Thrombophlebitis), with related codes reassigned to MS-DRGs 299–301 (Peripheral Vascular Disorders).
What’s changing with New Technology Add-on Payments (NTAP) in FY 2026?
There are 54 technologies approved for NTAP in FY 2026: 27 continuing from 2025, 5 newly approved via the traditional pathway, and 22 via the alternative pathway. Given the significant payment amounts associated with some technologies, accurate documentation and coding are crucial to ensure appropriate add-on reimbursement.
About Our Medical Coding Courses
HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a flexible, online education platform designed for today’s coders. With a growing catalog of AHIMA and AAPC-approved coding courses, HIAlearn supports both beginners and experienced coders looking to build confidence, accuracy, and CEU credits.
Courses are available across various coding types including CPT, E/M, ICD-10-CM, and ICD-10-PCS, and are designed for multiple specialties including inpatient, outpatient, profee, and CDI.
To stay up to date, coders can explore our Coding Updates hub for the latest ICD-10-CM, ICD-10-PCS, CPT, and IPPS changes. HIAlearn also supports organizations with group discounts and scalable team access, promoting accuracy, compliance, and continuous professional development across departments.
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