Q3 to Q4 2026 CMS Fee Schedule Update: Drug Payment, CLFS, DMEPOS, and RVU Changes

Executive summary

Of the 811 changed records, 800 were drug payment rate changes and 11 were RVU status-code changes. The 11 RVU records did not have changes to their work RVU, facility practice expense RVU, non-facility practice expense RVU, malpractice RVU, or conversion factor.

Schedule summary

Key Q4 2026 takeaways

1. Drug payment rates accounted for 848 of the 1,008 Q3-to-Q4 updates, or about 84% of all changes reviewed. Among existing drug codes, 800 payment rates changed, while another 38 codes were added and 10 were removed.
2. CLFS changes were entirely code-list updates. Forty code/modifier records were added and three were removed, but no existing Q3 CLFS rate changed in Q4. Most of the new CLFS records currently carry a zero fee-schedule amount.
3. DMEPOS changes were limited to additions and removals. Eight code/modifier combinations were added and one was removed, while no existing DMEPOS geographic rate set changed between Q3 and Q4.
4. RVU activity consisted primarily of new code rows. Ninety-seven code/modifier rows were added. Eleven existing rows had status-code changes, but their numeric RVU components and conversion factor remained unchanged.
5. No GPCI changes were identified between Q3 and Q4.
6. Zero-rate additions should be reviewed carefully before treating them as newly payable services. A code appearing in a fee-schedule file does not by itself establish Medicare coverage or payment in every circumstance.

Notable Q4 changes

1. The largest drug payment increase by dollar amount was Q2053, rising from $510,103.919 to $532,352.741, an increase of $22,248.822 (+4.36%).
2. Other large dollar increases included Q2041, up $15,442.366 (+2.75%); Q2042, up $14,622.663 (+2.39%); Q2054, up $10,276.157 (+1.77%); and Q2055, up $7,872.685 (+1.39%).
3. The largest drug payment decrease by dollar amount was J3402, falling from $203,659.763 to $202,159.938, a decrease of $1,499.825 (-0.74%). Other notable decreases included Q2043 (-$269.296) and J0801 (-$249.182).
4. Several lower-dollar drug codes had much larger percentage changes. J9304 increased from $7.994 to $92.505 (+1,057.18%), J3489 increased from $3.361 to $17.673 (+425.83%), and J2516 increased from $0.160 to $0.482 (+201.25%). Large percentage changes on low starting values should be interpreted alongside the actual dollar difference.
5. CLFS added 0442U with modifier QW at $41.38 plus codes 0660U through 0698U, which currently carry $0.00 rates in the Q4 file. Removed CLFS codes were 0556U, 0557U, and 0585U.
6. DMEPOS additions included A4228, A6614-NU, E0150-NU, E0150-RR, E0150-UE, E0788-RR, E2403-RR, and L1972. L8696 was removed.
7. RVU additions included the new 1054T through 1111T code series along with several new HCPCS rows. Among new RVU records, A2046, A2047, A2049, Q4207, Q4223, and Q4243 carry facility and non-facility practice expense RVUs of 3.81.
8. Ten existing RVU records — J0640, J1941, J1953, J7514, J7517, J7519, J7528, J9181, J9190, and J9352 — changed status from E to I. A2044 changed from a blank status to C. Their numeric RVU components did not change.

What this means for billing teams

Most Q4 2026 reimbursement movement is concentrated in Medicare Part B drug payment rates, so organizations billing J-codes and Q-codes should review their highest-volume and highest-dollar drugs first. The size of some percentage changes also makes it important to look at both percentage and absolute-dollar movement rather than relying on percentage change alone.

CLFS and DMEPOS require a different type of review. Their Q4 changes are primarily additions and removals rather than repricing of existing services. Billing teams should identify whether any newly added or removed codes intersect with their current workflows, but a zero fee-schedule amount or appearance in a CMS file should not automatically be interpreted as a coverage or payment determination.

The RVU update is similarly more structural than financial. Ninety-seven records were added, while the 11 existing records that changed had status-code changes rather than numeric RVU changes. GPCI remained unchanged between Q3 and Q4.

Official CMS sources

The Q3-to-Q4 comparison above is based on MedFeeSchedule's normalized review of CMS fee schedule data. The underlying Q4 source material is published by the Centers for Medicare & Medicaid Services.

• Medicare Part B Drug Payment Limit and ASP pricing files
• Clinical Laboratory Fee Schedule files
• DMEPOS fee schedule files
• HCPCS quarterly updates and Physician Fee Schedule relative value files

Full all-changes table

Use the filters below to narrow the Q4 update by schedule or change type. Each code links to its MedFeeSchedule code page for a closer look at current payment data.