Questions billers ask › How often do HCPCS codes change under Medicare rules?

How often do HCPCS codes change under Medicare rules?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“The HCPCS is updated quarterly to reflect changes in the practice of medicine and provision of health care. The CMS provides a file containing the updated HCPCS codes to A/B MACs (A), (B), (HHH), and DME MACs and Medicaid State agencies 60 to 90 days in advance of the implementation of each update. Distribution consists of an electronic file of the updated HCPCS codes, file characteristics, record layout, and a listing of added, revised and deleted codes. MACs are required to update their HCPCS codes file and map all new, revised, and deleted codes to appropriate payment information. An updated list of the HCPCS codes for Durable Medical Equipment Medicare Administrative Contractors (DME MAC) and A/B MAC (B) jurisdictions is updated quarterly to reflect codes that have been added or discontinued (deleted) during each year. A recurring update notification will be published to notify the DME MACs and A/B MACs (B) that the list has been updated and is available on the CMS Web site. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html. Both the DME MACs and the A/B MACs (B) publish this list to educate providers on which MAC they should bill for codes provided on this list. Physicians and suppliers must use HCPCS codes on the Form CMS-1500 or its electronic equivalent and providers must use HCPCS codes on the Form CMS-1450 or its electronic equivalent [...]”

Pub 100-04 Ch 23 § 20.3, 20.3 - Use and Acceptance of HCPCS Codes and Modifiers
Captured2026-05-24
sha256:5c990d44…5c06952f · Source

What our AI found in the sources

HCPCS codes are updated quarterly--in January, April, July, and October. CMS releases the updated HCPCS file to MACs 60 to 90 days before each quarterly implementation date. The file contains new, deleted, and revised codes effective for the upcoming quarter. CPT-4 codes (Level I) are published annually each October by the American Medical Association for the following year, while Level II alpha-numeric HCPCS codes are updated quarterly by CMS.

Also cited

Pub 100-04 Ch 23 § 20.4, 20.4 - Deleted HCPCS Codes/Modifiers
Captured2026-05-24
sha256:5c990d44…5c06952f · Source

If this comes up on one of your claims

The quoted paragraph above is what you would put in the appeal or the audit file, with its citation and dates. Verbatim does not tell you how to bill; it shows you the rule as published so the decision is yours and the proof is in writing.

Ask it your own question and get the same thing back: the governing rule, quoted, with a citation that still verifies later.

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