With the April 1 update, the Centers for Medicare and Medicaid Services (CMS) implemented 80 new PCS codes. To break it down, there are 24 new codes that are designated as operating room (OR) procedures. Fifty-six of the new codes are designated as non-OR procedures. Almost half of those 56 non-OR procedures, 27 to be exact, are non-OR procedures that influence Diagnosis-Related Group (DRG) assignment.
I always think the new technology sections are the most exciting, and one of the new codes I found interesting is XW0E33B, Introduction of DB-OTO via intracochlear infusion into ear(s), percutaneous approach, new technology group 11. DB-OTO is a dual adeno-associated virus 1 gene therapy. This exciting new technology is used in patients with congenital deafness due to a genetic deficiency of otoferlin, a protein critical to the synaptic transmission by sensory hair cells of the ear. Up to this point, there have been few medical treatment options available.
Children suffering from this type of deafness generally receive cochlear implants. This gene therapy delivers human OTOF complementary DNA (encoding otoferlin) regulated by a hair cell-specific promoter.
The New England Journal of Medicine published findings from their first-in-human registrational study in October 2025. After one infusion of DB-OTO, six out of 12 study participants could hear soft speech without any assistive device. Three of the twelve participants had average, normal hearing sensitivity. This success using gene therapy gives hope to those with congenital deafness, as well as those with conditions for which other gene therapies hold promise.
In terms of our new technology codes, we know from our updates that they generally have a three-year timeframe before expiring. There have been ongoing assessments on what to do with new technology X codes that are more than three years old. Four options were noted.
Option 1 is to keep the X code as is. Option 2 is to delete the X code and incorporate the new technology it represents into another section, as appropriate (for example, if there is a new technology add-on for a fusion technology, it would be incorporated into the fusion code itself, possibly as a qualifier value). Option 3 would be to delete the X code completely, not incorporating the technology represented into the classification at all (this may happen when a technology is no longer used, perhaps due to a newer technology taking its place). The last option involves creating a totally new code that incorporates the technology into it.
Among the new codes that aren’t new technology-related are 18 wound management codes involving the musculoskeletal and integumentary systems of the thorax and abdomen. These involve different modalities, including negative pressure therapy, orthosis, prosthesis, and electrotherapeutic equipment, to name a few.
Be sure you and your team review these. They are non-OR procedure codes that have an effect on MS-DRG assignment.
Finally, we have 20 new endoscopic drainage codes involving sites in the digestive and biliary systems. All these codes involve a drainage device and have qualifier values of either transmural or transcapillary. These are all designated as non-OR procedure codes and are usually performed by interventional radiology. If your providers or facilities perform this type of procedure, you will want to be watching for this documentation.
Make sure you and your team review these new codes that will remain effective through Sept. 30 discharges.
That’s how Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz announced the publication of the CMS Final Rule on the Adoption of Standards
It just seems that a week does not go by when an insurance company doesn’t develop a new policy that leads to confusion in the
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