January 2026 Newsletter

We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services.

January HCPCS Codes Available for Download

CMS has made the January HCPCS medical billing codes available to the public for download as of January 12, 2026. They can be accessed under file name: January 2026 Alpha-Numeric HCPCS File (ZIP) [1].

New ICD-10 Codes Introduced

CMS has announced the implementation of 80 new ICD-10 codes. These codes fall under version 43.1 and are effective for discharges on or after April 1, 2026. They include medical coding updates for procedures that cover pacemakers, defibrillators, gallbladder drainage, and resection of the prostate [2].

PEPPER Relaunch for Short-Term Acute Care Hospitals

The Agency has relaunched the hospital billing Program for Evaluating Payment Patterns Electronic Report (PEPPER) for short-term acute care hospitals. Currently, only authorized officials and access managers can download reports from the PEPPER portal [3].

NCCI Policy Manual Released

CMS has posted the NCCI Policy Manual for Medicare Services for this year. Additional prior medical coding revisions are available in the archive. This new release is effective January 1, 2026. Additions and revisions are presented in red font [4].

Mandatory GUARD Drug Payment Model Proposed

CMS has proposed the mandatory Guarding U.S. Medicare Against Rising Drug Costs (GUARD) model with the intent of lowering spending. It is intended to do so without reducing quality of care while simultaneously improving sustainability of the Medicare program and Medicare Trust Fund [5].

CMS Releases BALANCE Model

The Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) has been released by CMS and could impact medical billing and coding. It has a goal of increasing access to GLP-1 medications and other lifestyle interventions. The model is voluntary and will involve CMS negotiating drug pricing and coverage terms on behalf of state Medicaid agencies and Medicare Part D plan sponsors [6].

$50 Billion Awarded to Help Rural States

CMS has announced $50 billion in awards under the Rural Health Transformation Program. States will receive first-year awards averaging $200 million, ranging between $147 million and $281 million. The funds are intended to help states in strengthening rural health workforces, expanding access in rural communities, supporting innovation, and modernizing rural facilities and tech, a potential benefit to medical billing accounts receivable departments [7].

Withdrawal of Final Local Coverage Determinations of Skin Substitutes 

MACs are withdrawing Local Coverage Determinations for Skin Substitute Grafts/Cellular and Tissue-Based Products involved in the treatment of Diabetic Foot Ulcers and Venous Leg Ulcers. The LCDs were scheduled to become effective on January 1, 2026 and the withdrawal is effective immediately for medical billing and coding [8].

Request for Pitches to Overhaul Medicare Claims Processes

CMS has a goal of replacing four legacy Medicare claims platforms and is looking for a vendor to design one to assume all system responsibilities. It has issued a request for information as of January 8 for building the new platform, ClaimsCore, which will impact USA medical billing [9].

HHS Sued over $10B Funding Freeze

Five states, California, Colorado, Illinois, Minnesota, and New York have filed a federal lawsuit over HHS’ decision to freeze $10 billion that supports child care programs for low-income families. The programs supported include the Child Care and Development Fund, the Temporary Assistance for Needy Families program and the Social Services Block Grant [10].