Beginning on October. 01, 2026; CMS will add 19 new HCPCS Codes to their "non-routine supplies" section of their home health consolidated billing list. Therefore, if your home healthcare organization, or DME supply business submits separate charges for supplies that are provided to a patient under the direction of a home healthcare plan-of-care, these changes will affect both what you can submit separately and what will be routed through the patient's primary home health provider.
Quick Answer
CMS finalized CR #14510 which added 19 HCPCS codes to the Home Health Consolidated Billing (HHCB) Non-Routine Supply List on Oct. 1, 2026.
These new codes will include syringe, catheters, ostomy irrigating equipment & supplies, incontinence inserts, and wound care tape.
Codes will not be eligible for separate payment for claims made by patients who are receiving a Home Health Episode at that time; rather they will go directly to the Primary HHA for reimbursement.
MAC Systems will begin applying this change on Oct. 5, 2026, four (4) days subsequent to the Effective Date.
What Is Home Health Consolidated Billing?
Home Health Consolidated Billing is actually pretty easy to understand. The concept is straightforward. When a Medicare Patient has an active home health plan of care; there are very few instances when someone will be paid (the primary) HHA for almost all of the items and services related to that episode. These include supplies, therapies, etc. which would have been billed as separate bills from other agencies/providers had it not been for the consolidation of these bills into the primary HHA.
The Primary HHA is usually the first agency to submit a "Notice of Admission" for the patient. Once that notice has been submitted; no other billing entity can obtain payment for any supply on the consolidated billing list regardless of whether or not the supply was physically delivered to the patient's home.
DME does NOT fall under the consolidated billing regulations, nor does the direct therapeutic service provided by a physician, nor does DME supplied due to physician services, nor does any DME used in an Institutional Setting.
What's New: 19 Codes Added October 1, 2026
CMS will be releasing this update as part of Change Request 14510 (Transmittal R13794CP) effective July 8, 2026. This release will go live on Oct. 1, 2026 with all Medicare Administrative Contractor (MAC) systems to be updated by Oct. 5, 2026.
Here is an example of some of those codes listed above:
| HCPCS Code | Description |
|---|---|
| A4206–A4209 | Sterile syringes with needle, various sizes |
| A4211 | Supplies for self-administered injections |
| A4318 | Female external urinary collection cup |
| A4336, A4337 | Urethral and rectal incontinence inserts |
| A4397–A4400 | Ostomy irrigation sleeves, bags, cones, and sets |
| A4450, A4452 | Non-waterproof and waterproof tape |
| A4453 | Rectal catheter for transanal irrigation systems |
There are many other codes included in the full list including A4210 (needle free injection devices); A4218 (metered-dose saline dispensing devices); and A4341/A4342 (indwelling intra urethral drainage devices & their accessories). These 19 codes are added to Medicare Claims Processing Manual, Chapter 10, Section 20.
CMS issues these lists every year. Additionally CMS will issue supplemental listings on an annual basis for any new temporary k-codes that are added throughout the year. This listing was simply adding additional categories of supplies that were already considered non-routine supplies.
Impact on Providers and Billing Teams
If your organization has billed one of these 19 CPT/HCPCS codes for a patient who is currently under a Home Health Episode (HHE), you will need to have this claim submitted to the primary Home Health Agency (HHA) by October 1, 2026. The claims should be submitted individually as they are likely to be denied.
The DME Suppliers are probably feeling the weight of this the most. A DME Supplier who has been billing Syringes, Catheters, Ostomy Supplies, etc., directly to Medicare for a patient who is receiving Home Health Services, will need to establish a new process prior to the Effective Date. In many cases this means verifying if the patient is eligible for Medicare and also has an Active Home Health Episode before processing and submitting any Claim with one of these Codes.
Home Health Agencies are impacted differently than DME Suppliers. As the Primary HHA, you are now liable for the Financial responsibility of either providing or Reimbursing for those same nineteen (19) Items during the Episode. This is a Cost that should appear on your Care Planning Budgets and Supply Budgets, not simply on Your Billing Software Update.
Impact on Payers and Patients
Typically, patients will continue to receive their medical supplies as usual. Supplies are ordered and shipped; and the Home Health Agency (HHA) continues to be responsible for developing and implementing the Plan of Care. The primary differences are with regards to who actually submits claims to whom, and who ultimately receives reimbursement.
With respect to Medicare, consolidated billing eliminates a loophole in which the same type of medical supply could be billed two different times. This can occur when a Durable Medical Equipment (DME) supplier bills separately for the supplies, while at the same time the HHA includes those very same items within its bundle of services included in its total payment. Consolidated Billing was created solely to eliminate such duplicate payments.
What Should Your Billing Team Do Now?
With just four weeks of runway time, here is everything that should be completed prior to October 1, 2026.
1. Update your billing software's edit list.
To include each one of the nineteen (19) CPT Codes to be included as part of your consolidated billing denial prevention edits; therefore, preventing claim submissions from being denied due to these edits rather than upon receiving a denial.
2. Cross reference your active home health episodes.
Prior to submitting claims for any of these codes, verify if the patient has an active Notice of Admission with a Home Health Agency (HHA).
3. Notify your DME vendors/suppliers.
As the primary HHA vendor/supplier, notify your DME vendors/suppliers as these will now go through your agency.
4. Train your billing personnel on exception rules.
Although physician performed therapy and institutional setting supplies are billed separately, ensure your personnel are able to identify which category the item(s) fall under.
5. Be aware of potential denials in the first week of October.
The MAC system updates occur on October 5th; this is approximately 4-5 days post-dated from when the changes take effect. Therefore, if you have received denials during this period, it may be beneficial to review those claims again.
Not getting this correct does not only impact one claim. It establishes a denial process which can be weeks or even months to resolve, and at some point many times a third party denial management service will be brought into the picture for assistance once the damage has already been done rather than ahead of time.
Frequently Asked Questions
October 1, 2026. All Medicare Administrative Contractors (MAC) systems should have caught up with the changes by October 5, 2026.
No. As mentioned above, Durable Medical Equipment continues to remain exempt from Home Health Consolidated Billing. This is because the 19 codes being added for non-routine supplies will continue to be billed as part of the non-routine supply category; which is different from DME.
Primarily the primary Home Health Agency (HHA), who submitted the Notice of Admission for that patient's home health episode.
Medicare cannot reimburse it as long as the patient remains under a current Home Health Plan of Care. Claims are denied most often due to Medicare not paying for services while there is an existing Home Health Plan of Care.
Bottom Line
The four week window will provide sufficient time for all of your systems to be updated. It is those billing teams who do not audit their edit list by Oct 01 that have an appeal filed Nov 01. Human Medical Billing helps Home Health Agencies & Post Acute Providers build updates to code lists such as this one into their daily claims edits rather than finding them out from a denial. If your agency needs assistance reviewing your current HH CB Edit Rules - contact us, we would be happy to help review with you.
Contact Human Medical Billing to schedule a compliance readiness review or learn more about our end-to-end billing and regulatory support services.
