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Q2 2026 I/OCE Release (v27.1)

Effective Date: April 1, 2026
Reference Dataset: CMS Q2 2026 Quarterly Data Files

CMS has released the Q2 2026 Integrated Outpatient Code Editor (I/OCE) specifications (v27.1) for processing outpatient institutional claims. This update is now live in the Bedrock Billing Prospective API to support April 1st effective dates.

Below is an overview of the broader billing impacts and logic refinements contained in this release.

Retrospective Processing Extension

[!IMPORTANT] 28 Quarter Maintenance The I/OCE software and our data models have been updated to maintain exactly 28 prior quarters (7 years) of logic programs in each release. Older versions are removed with each subsequent release.

For this V27.1 release, the earliest date/version supported is July 1, 2019 (v20.2).

Logic Refinements & Core Billing Impacts

Discounting Logic Correction for Terminated Procedures

A crucial discounting logic correction has been implemented for claims reporting a single Status Indicator (SI) = T line item. The software now ensures the appropriate terminated procedure discount is successfully applied when a termination modifier (52 or 73) is billed identically alongside a repeat procedure modifier (76, 77, 78, 79).

Non-Opioid Surgical Pain Relief Device & Drug Processing

CMS has updated logic for Non-Opioid Post-Surgical Pain Relief to correctly assign billing paths and limit processing: - Status Indicators R, S1, and U have been explicitly removed from the "OPPS Payable" designation in the application of Edits 98 and 99. - New non-opioid devices C9810–C9817 (retroactive to 1/1/2026) and C9818 (mid-quarter, effective 1/23/2026) with SI = H1 have been accurately identified as non-opioid devices subject to payment limitation. - The I/OCE tables now incorporate a novel NON_OPIOID_DEVICE column to distinguish non-opioid payment limitation devices (SI = H1) from standard pass-through devices (SI = H).

Vaccine Bypasses

Edit 127 processing logic has been updated to bypass all vaccine products universally with SI = L retroactively to July 1, 2019, as well as bypass all services present on the coinsurance/deductible N/A list.

FQHC Chronic Care Management (CCM) Additions

The FQHC Chronic Care Management capabilities have been extended to broadly cover standard Telehealth and assessment logic. The following HCPCS codes have been explicitly added to the FQHC CCM list (retroactive to Jan 1, 2026) and simultaneously removed from the Non-Covered list: - 98016, 99492, 99493, 99494 - G0568, G0569, G0570, G2010, G2214, G2250

Additional Revisions

  • Unacceptable Principal Diagnoses: The unacceptable principal diagnosis flag (Edit 113) has been removed from F07.81 and H40.841–H40.849.
  • Radiopharmaceutical Thresholds: Broad adjustments were made to the radiopharmaceutical HCPCS list distinguishing codes whose pricing exceeds threshold boundaries.
  • Mid-quarter Vaccine Status Change: HCPCS 90624 has been updated mid-quarter to SI = M.

[!NOTE] For deep-dive research into every individual HCPCS code, edit modification, and data table adjustment, please refer to the official CMS Quarterly Release Files.