CY 2026 Comprehensive APC Payment Policy Exclusions
Ambulance services
Brachytherapy
Diagnostic and mammography screenings
"Physical therapy, speech-language pathology and occupational therapy services reported on a separate facility claim for recurring services"
"Pass-through drugs, biologicals, and devices"
Preventive services defined in 42 CFR 410.2
Self-administered drugs (SADs) - Drugs that are usually self-administered and do not function as supplies in the provision of the comprehensive service
"Services assigned to OPPS status indicator ?F? (certain CRNA services, Hepatitis B vaccines and corneal tissue acquisition)"
"Services assigned to OPPS status indicator ?L? (influenza, pneumococcal pneumonia, and COVID-19 vaccines)"
"Certain Part B inpatient services ? Ancillary Part B inpatient services payable under Part B when the primary ?J1? service for the claim is not a payable Medicare Part B inpatient service (for example, exhausted Medicare Part A benefits, beneficiaries with Part B only)"
Services assigned to a New Technology APC 
Any drug or biological described by HCPCS code C9399
"Non-opioid products qualifying under section 4135 of the Consolidated Appropriations Act (CAA), 2023 (For status indicators H1 and K1)"
Cell and gene therapies
