Restated Drug and Biological Payment Rates

The OPPS and ASC payment systems typically communicate billing instruction changes through quarterly Change Requests (CR), with the Integrated Outpatient Code Editor (I/OCE) reflecting updates to HCPCS codes, status indicators (SIs), payment indicators (PIs), ambulatory payment classifications (APCs), HCPCS modifiers, and revenue codes. The restated drug files found below on this page list payment rates that are corrected retroactively for certain OPPS drugs, biologicals, and radiopharmaceuticals for a particular quarter.

CMS has taken steps to ensure timely payment for drugs, biologicals, and radiopharmaceuticals, such as the Invoice Drug Pricing Policy (89 FR 94243 through 94244), which is effective January 1, 2026. Until that policy is effective, we anticipate that there may be cases where there is a significant interval between a payment status change and when it can be operationally effectuated. Therefore, we are listing here anticipated changes of which we are currently aware (as of August 2025). We anticipate the following status indicator changes for the following HCPCS code(s):

October Update HCPCS code(s):

• Q9997 is currently non-payable under OPPS, will change to “K,” retroactive to July 1, 2025.
• J0283 is currently non-payable under OPPS, will change to “N,” retroactive to July 1, 2025.
• J0874 is currently non-payable under OPPS, will change to “N,” retroactive to July 1, 2025.
• J2246 is currently non-payable under OPPS, will change to “N,” retroactive to July 1, 2025.
• J9076 is currently non-payable under OPPS, will change to “K,” retroactive to July 1, 2025.
   

Restated Payment rates for Outpatient Prospective Payment System (OPPS) drugs and biologicals for each quarter.