Multi-Specialty ICD-10 NCD Coding Revisions: Update Systems Before January 4
CMS Transmittal R13903OTN (CR 14570) implements ICD-10 and NCD coding revisions effective January 4, 2027 — system updates required now.
Action required by
January 4, 2027
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13903OTN, Change Request (CR) 14570, published under Publication 100-20, implements ICD-10 and other coding revisions to National Coverage Determinations (NCDs) with an implementation date of January 4, 2027. This is a Transmittal — not a proposed rule — meaning these changes are final and require action before the go-live date. The single most important compliance implication: any claims processing system, encoder, or grouper that references NCD-linked ICD-10 codes must be updated prior to January 4, 2027 to avoid claim rejection or incorrect coverage determination application.
Regulatory Background
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Quick answers
Does CR 14570 affect both Part A institutional claims and Part B professional claims, or only one claim type?
NCD coverage edits are applied at the Common Working File (CWF), which processes both FISS-adjudicated Part A institutional claims (837I) and MCS-adjudicated Part B professional claims (837P). Both claim types are subject to the updated ICD-10 NCD code mappings effective January 4, 2027.
This is labeled '2 of 2' — do I need to review a companion transmittal as well to capture all NCD code changes for January 2027?
Yes. CR 14570 is split across two transmittals for the January 2027 ICD-10 revision cycle. Transmittal R13903OTN covers part two of the NCD code changes; a separate '1 of 2' transmittal covers the remainder. Both documents must be reviewed together to identify the complete set of affected ICD-10 codes across all impacted NCDs.
How do I determine which specific NCDs and ICD-10 codes are affected by R13903OTN?
The specific NCD titles and ICD-10 code-level changes are not enumerated in the transmittal header; they appear in the full CR 14570 attachment tables. Access the complete document at https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13903otn and review the NCD code list tables for every addition, deletion, and revision that takes effect January 4, 2027.
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.