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Policy & oversight

CMS Published Second-Quarter 2026 Drug Coding Decisions That Shape How Medicare Identifies and Pays for New Medicines

The quarterly HCPCS drug coding update, posted July 29 and highlighted in the August 6 MLN Connects newsletter, determines which new medications and biologicals get a dedicated Medicare billing code.

By the Goodsurance editorial teamAugust 6, 2026

The Centers for Medicare and Medicaid Services posted application summaries and coding determinations for second-quarter 2026 drugs and biologicals on July 29, 2026. The update was highlighted in the August 6, 2026 MLN Connects provider newsletter.

The Healthcare Common Procedure Coding System, known as HCPCS, uses alphanumeric codes to identify specific medical products and services for billing. When a drug or biological product receives a permanent HCPCS Level II code, providers can bill Medicare for it as a distinct line item. That designation affects coverage, payment rates, and beneficiary cost sharing.

CMS reviews coding applications from manufacturers and other interested parties four times a year. For each application, CMS publishes a description of the request and its determination. Drugs and biologicals that lack a specific code are typically billed under broader general codes, which can result in different payment rates and less precise tracking of utilization.

The Q2 2026 determinations cover applications submitted in that quarterly cycle. CMS also announced that an October 2026 HCPCS update file would be published separately, adding codes for drugs and biologicals that received temporary designations since the last quarterly review.

The coding decisions apply program-wide. Medicare Advantage plans are required to cover all services and drugs that original Medicare covers, using the same HCPCS codes, so a new code established under original Medicare applies across both program types.

In plain words

CMS published a list of decisions about billing codes for new drugs and medicines. These codes matter because they help determine if Medicare will pay for a drug and at what rate. When a new drug gets its own code, it is easier for doctors to bill for it and for Medicare to track its use. CMS does this review four times a year. The latest list covers the second quarter of 2026 and was published in late July. A separate update with additional codes is planned for October.

Understand the basics first

Source: CMS
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