PFS Quarterly MPFSDB Update July 2026: Verify Fee Schedule Changes Now
CMS Transmittal R13845CP updates the MPFSDB effective July 6, 2026 (verify against source document) — review affected PFS codes before claims submission.
Action required by
July 6, 2026
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13845CP implements the quarterly update to the Medicare Physician Fee Schedule Database (MPFSDB), with an effective date of July 6, 2026 (verify against source document). This is an administrative transmittal — not a Final Rule or LCD — and affects the Physician Fee Schedule (PFS) payment system across all MAC jurisdictions processing professional claims. The single most important compliance implication: any PFS code whose status indicator, relative value unit (RVU) assignment, or payment policy indicator changed in this quarterly load will process incorrectly on claims submitted against a stale fee schedule after July 6, 2026 (verify against source document).
Regulatory Background
Sign in to read the full article
Create a free account to access the complete analysis, action recommendations, and related alert references.
Quick answers
Does R13845CP apply only to professional (837P) claims, or does it also affect outpatient facility (837I) claims processed under OPPS?
The R13845CP transmittal updates the Medicare Physician Fee Schedule Database (MPFSDB), which governs PFS adjudication on professional (837P) claims. OPPS payment rates for outpatient facility (837I) claims are governed by the Outpatient Prospective Payment System, not the MPFSDB. However, MPFSDB status indicators — particularly for codes subject to packaging or bundling under both systems — can indirectly affect how MACs process professional component claims billed alongside facility claims. Confirm with your MAC whether any codes in the R13845CP update affect shared-system edits that touch 837I professional component billing.
How do I identify which specific codes changed in the R13845CP quarterly update before the July 6, 2026 effective date?
The affected code list is contained in the attachment files published with Transmittal R13845CP at the CMS transmittals page. Access the full document at https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13845cp and download the MPFSDB data files, which enumerate each code with its revised status indicator, RVU values, and payment policy indicators. Cross-reference those codes against your CDM and encoder. Note that the July 6, 2026 effective date carries a 'verify against source document' flag — confirm the go-live date in the transmittal itself before finalizing your update schedule.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.