CMS MLN Matters MM14653 (CR 14653) revises ICD-10 and other coding edits for six National Coverage Determinations, effective April 1, 2027, with MAC implementation April 5, 2027. No NCD policy changed. Update edits for VAD, TEB, HBO, NGS, aprepitant, and heart transplants.
| NCD | Title | What CR 14653 changes for coding teams |
|---|---|---|
| 20.9.1 | Ventricular Assist Devices | End-date I42.0, I42.8, I49.8 (9/30/2026); add I42.01, I42.09, I42.81, I42.89, I47.22, I49.81, I49.82, I49.89 (10/1/2026) |
| 20.16 | Cardiac Output Monitoring by TEB | End-date I42.0, I42.8 (9/30/2026); add I42.01, I42.09, I42.81, I42.89 for covered CVD indications (10/1/2026) |
| 20.29 | Hyperbaric Oxygen Therapy | End-date M86.8X1-M86.8X8 (9/30/2026); add laterality-specific M86.8X11-M86.8X89 osteomyelitis codes (10/1/2026) |
| 90.2 | Next Generation Sequencing | Allow CPT 81459 for PGDx elio tissue complete CDx from FDA approval 7/30/2026 until a PLA code is established |
| 110.18 | Aprepitant for Chemotherapy-Induced Emesis | Add HCPCS J9066 (bendamustine hydrochloride, avyxa, 1 mg) to associated chemo drug list (10/1/2026) |
| 260.9 | Heart Transplants | Same cardiomyopathy and arrhythmia ICD-10 swaps as NCD 20.9.1 |
Figures and code lists above come from MLN Matters MM14653 and Transmittal R14022OTN / CR 14653 , with the linked NCD spreadsheets for CR 14653 . CMS released the CR on 23 October 2026; the MLN article history marks the initial article on 27 October 2026. The MLN Connects newsletter for 5 November 2026 flagged the update for physicians, suppliers, and other providers who bill MACs.
What MM14653 is (and is not)
MM14653 is a quarterly maintenance update. CR 14653 refreshes ICD-10 conversions and other coding updates tied to existing NCDs. The transmittal says no policy changes with these updates. Coverage criteria stay put. The code list each NCD edit reads when a claim hits the MAC is what moves.
Coding teams often treat every NCD CR as a clinical coverage rewrite. This one is an edit-table job. Remove retired ICD-10 values, load the replacements, map new CPT or HCPCS lines where CMS named them, and retest claims that used the old codes. For how national rules sit next to local ones, see our LCD vs NCD coverage check .
CMS also notes that ICD-9 to ICD-10 translations were never clean one-to-one matches. GEM-style mapping is not a stand-in for reading each NCD against its current ICD-10 list. GEMs mapping itself stopped as of 1 October 2019. Rebuild edits from the CR 14653 spreadsheets, not from a legacy crosswalk.
Why April 2027 still matters when many codes move on 1 October 2026
Several business requirements in R14022OTN end-date diagnoses on 30 September 2026 and add replacements on 1 October 2026. That lines up with the FY2027 ICD-10-CM update. The CR is still the April 2027 NCD coding quarterly: effective date of service 1 April 2027, MAC implementation 5 April 2027.
Plan two checkpoints. First, confirm your encoder, payer edits, and charge rules already reflect the 1 October 2026 ICD-10 expansions for cardiomyopathy, arrhythmia, and osteomyelitis laterality. Second, confirm the NCD-specific edit packages your MAC and clearinghouse use will carry those same values when the April 2027 NCD quarterly loads. A shop that updated general ICD-10 files in October can still fail an NCD edit in April if the NCD spreadsheet never reached the coverage module.
MACs will not search paid history for you. MM14653 says MACs will not search for claims, but will adjust claims providers bring to their attention. If a denied or underpaid line used a now-retired diagnosis under NCD 20.9.1, 20.16, 20.29, or 260.9, your team finds it and reopens it.
The six NCDs and the edits that touch claim lines
NCD 20.9.1 Ventricular Assist Devices and NCD 260.9 Heart Transplants
Both NCDs share the same cardiomyopathy and arrhythmia swap in CR 14653. Contractors end-date ICD-10-CM I42.0, I42.8, and I49.8 effective 30 September 2026. They add I42.01, I42.09, I42.81, I42.89, I47.22, I49.81, I49.82, and I49.89 effective 1 October 2026.
A note that only says "dilated cardiomyopathy," with no familial-genetic versus other detail, or that leaves an arrhythmia at unspecified I49.8, will not map cleanly into the new covered list. Update query rules and CDI tips for VAD and transplant workups so the finer codes land before the claim leaves coding.
NCD 20.16 Cardiac Output Monitoring by TEB
For thoracic electrical bioimpedance cardiac output monitoring, contractors end-date I42.0 and I42.8 on 30 September 2026 and add I42.01, I42.09, I42.81, and I42.89 to the covered list for suspected or known cardiovascular disease effective 1 October 2026. TEB volume is lower than VAD work in most shops. The cardiomyopathy specificity problem is the same. If your cardiology panel bills TEB, refresh the diagnosis pick-list now.
NCD 20.29 Hyperbaric Oxygen Therapy
HBO takes the largest diagnosis list change in this CR. Contractors end-date M86.8X1 through M86.8X8 effective 30 September 2026 and add laterality- and site-specific codes M86.8X11, M86.8X12, M86.8X21, M86.8X22, M86.8X31, M86.8X32, M86.8X41, M86.8X42, M86.8X51, M86.8X52, M86.8X61, M86.8X62, M86.8X71, M86.8X72, M86.8X80, M86.8X81, and M86.8X89 effective 1 October 2026.
The new codes name other osteomyelitis by shoulder, upper arm, forearm, hand, thigh, lower leg, ankle and foot, skull, face and sinuses, and other site, with right and left where laterality applies. Wound care and HBO programs that still drop a non-lateral M86.8Xx parent will fail the NCD edit after the swap. Build documentation templates that force site and laterality before the coder sees the chart.
NCD 90.2 Next Generation Sequencing
On the lab side, CR 14653 tells contractors to add CPT 81459 for PGDx elio tissue complete CDx from the 30 July 2026 FDA approval date until a specific PLA code is established. CPT 81459 describes a solid organ neoplasm genomic sequence analysis panel (DNA or combined DNA and RNA analysis), including copy number variants, microsatellite instability, tumor mutation burden, and rearrangements. The CR 14653 NGS spreadsheet also carries companion ICD-10 lists for that assay and for other recently added tests such as Guardant360 Liquid CDx and Oncomine Dx Express.
Confirm 81459 sits on your NCD 90.2 covered-CPT list in the billing system, and keep a watch item to swap to the PLA once CMS publishes one. Pair the CPT with an ICD-10 from the assay-specific spreadsheet tab, not from a generic neoplasm shortcut list.
NCD 110.18 Aprepitant for Chemotherapy-Induced Emesis
Contractors add HCPCS J9066, injection, bendamustine hydrochloride (avyxa), 1 mg, to the chemotherapeutic drug list tied to the aprepitant policy, effective 1 October 2026. Put the new J-code on the chemo drug panel that drives the three-drug antiemetic edit. If bendamustine (avyxa) already sits on formulary under a different code, reconcile the charge master so the NCD-associated list and the billed HCPCS match.
What breaks when NCD edits and charts disagree
Here is how these misses show up on the desk. A VAD or transplant claim still carries I42.0 after 1 October 2026. An HBO episode for osteomyelitis bills M86.8X5 without laterality. An NGS claim for PGDx elio tissue complete CDx uses an unlisted code the NCD edit does not recognize. The MAC returns a coverage denial with CORE-style messaging (CMS points MACs to RARC N386 with CARC 50, 96, and/or 119 where appropriate), and the account sits until someone opens the NCD spreadsheet.
This is not a coverage-criteria fight. The clinical indication may still meet the NCD. The code on the line does not match the maintenance list CMS published in CR 14653. Put this quarterly on the RCM medical coding work queue next to fee schedule updates, not only on the coverage committee agenda.
Practical checklist before April 2027
- Download MM14653, R14022OTN, and the CR 14653 NCD spreadsheet zip from CMS and store them with your FY2027 ICD-10 files.
- Diff your current NCD edit tables for 20.9.1, 20.16, 20.29, 90.2, 110.18, and 260.9 against the spreadsheet tabs.
- Retire I42.0, I42.8, I49.8, and M86.8X1 through M86.8X8 from NCD-covered lists on the dates CMS names.
- Load the replacement cardiomyopathy, arrhythmia, and osteomyelitis codes, plus J9066 and CPT 81459 where those NCDs apply.
- Update CDI and provider tip sheets for dilated cardiomyopathy specificity, arrhythmia detail, and osteomyelitis laterality on HBO cases.
- Pull a sample of open or recently denied claims under these six NCDs and decide which ones to bring to the MAC, since MACs will not search on their own.
- Retest encoder and scrubber output on a small VAD, HBO, NGS, TEB, transplant, and antiemetic set before the April 2027 implementation date.
A focused medical coding audit on those six NCD families gives you a baseline before the quarterly edit flips. If a physician group or hospital outpatient department shares a coding vendor, confirm that vendor loaded the same spreadsheet version you audited.
MediCodio AI keeps coding in two lanes. Complete charts flow through AutoPilot for fully autonomous coding. Charts where the documentation is thin or contradictory stay in CoPilot, where certified coders review and finalize the output. Every code ships with its documentation passage and the compliance rule behind it. That trail helps when an NCD edit changes under you.
Frequently asked questions
Does MM14653 change Medicare coverage criteria for these NCDs?
No. Transmittal R14022OTN and MM14653 both state that CR 14653 is a maintenance update of ICD-10 and other coding tied to existing NCDs, and that no policy is being changed. Coverage criteria stay on the longstanding NCD path. What changes is the code list each NCD edit uses when a claim is processed.
When do the April 2027 NCD coding revisions take effect?
The CR effective date is 1 April 2027 for dates of service, and Medicare Administrative Contractors implement on 5 April 2027. Several ICD-10 and HCPCS list changes inside the business requirements end-date or add codes on 30 September 2026 and 1 October 2026, so encoder files and NCD edits both need a check.
Which NCDs does CR 14653 update?
CR 14653 updates coding for NCD 20.9.1 Ventricular Assist Devices, NCD 20.16 Cardiac Output Monitoring by TEB, NCD 20.29 Hyperbaric Oxygen Therapy, NCD 90.2 Next Generation Sequencing, NCD 110.18 Aprepitant for Chemotherapy-Induced Emesis, and NCD 260.9 Heart Transplants. Physicians, suppliers, and other providers who bill MACs are in scope.
Will my MAC automatically reopen claims that used the old ICD-10 codes?
No. MM14653 states that MACs will not search for claims but will adjust claims you bring to their attention. Coding and billing teams need to identify affected VAD, TEB, HBO, NGS, aprepitant, and transplant claims and submit the adjustment requests themselves.
What should coding teams do with CPT 81459 under NCD 90.2?
Contractors must add CPT 81459 for PGDx elio tissue complete CDx from the 30 July 2026 FDA approval date until a specific PLA code is established. Confirm 81459 is on your NCD 90.2 covered-CPT list, pair it with an ICD-10 from the assay spreadsheet tab, and watch for the PLA replacement.
If your team is testing NCD edit packs for VAD, HBO, and NGS against the CR 14653 spreadsheets ahead of April, Book a Demo and run the workflow on your own charts.
Related reading: LCD vs NCD coverage check · AI medical coding · RCM medical coding · How MediCodio AI supports RCM companies · Medical coding audit services · Physician groups
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