Hospital & Practitioner PTP Edits

Hospital PTP Edits
Effective January 1, 2026

Hospital PTP Edits v320r0 (475,004 Records) 0001A/0591T -- 24345/G0471 
Hospital PTP Edits v320r0 (475,125 Records) 24346/0213T -- 36563/G0471 
Hospital PTP Edits v320r0 (474,986 Records) 36565/0213T -- 61626/G0471 
Hospital PTP Edits v320r0 (433,720 Records) 61630/0213T -- U0003/U0004 

Practitioner PTP Edits
Effective January 1, 2026

Practitioner PTP Edits v320r0 (675,063 Records) 0001A/0591T -- 25505/J2001
Practitioner PTP Edits v320r0 (675,131 Records) 25515/01810 -- 37700/G0471 
Practitioner PTP Edits v320r0 (674,867 Records) 37718/0213T -- 62369/G0453
Practitioner PTP Edits v320r0 (602,358 Records) 62370/0213T -- U0003/U0004  

CARC and RARC Remark codes

Remittance Advice Remark Codes | X12
Claim Adjustment Reason Codes | X12

Outpatient Prospective Payment System Drug Acquisition Cost Survey Starts January 1

An April 15 Executive Order requires the HHS Secretary to conduct a survey under section 1833(t)(14)(D)(ii) of the Social Security Act to determine the hospital acquisition cost for covered outpatient drugs at hospital outpatient departments. On November 25, the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule established the OPPS Drug Acquisition Cost Survey (ODACS).

CMS will conduct the survey from January 1 – March 31, 2026, via the Fee-for-Service Data Collection System. The purpose of the survey is to gather accurate drug acquisition costs for select covered outpatient drugs and biological products purchased by hospitals paid under the Medicare Hospital OPPS. We intend to use survey results to inform policymaking starting with the CY 2027 OPPS and ASC proposed rule.

Hospitals that received OPPS payments for outpatient drugs from July 1, 2024 – June 30, 2025, must complete the survey and report data on all payable outpatient drugs purchased during this period. If you haven’t confirmed your Point of Contact for this initiative, email OPPSDrugSurvey@cms.hhs.gov as soon as possible and include your hospital's CMS Certification Number. 

Telehealth FAQ for CY 2026 HERE

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