Q3 2026 I/OCE Release (v27.2)¶
Effective Date: July 1, 2026
CMS has released the Q3 2026 Integrated Outpatient Code Editor (I/OCE) specifications (v27.2) for processing outpatient institutional claims. This update is now live in the Bedrock Billing platform to support July 1st effective dates. Additionally, this update incorporates CMS's newly released Java modules for the IOCE and OPPS Pricer for enhanced calculation accuracy and performance.
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 V27.2 release, the earliest date/version supported is October 1, 2019 (v20.3).
Logic Refinements & Core Billing Impacts¶
New Java Modules for IOCE and OPPS Pricer¶
CMS has transitioned to new Java-based modules for both the IOCE and OPPS Pricer. The Bedrock Billing API and Web UI have fully integrated these new modules to ensure the highest degree of accuracy, compliance, and performance for processing your claims.
Telehealth Services Processing¶
A new edit (Edit 139) has been introduced for OPPS hospitals and Critical Access Hospitals. The claim will be returned to the provider (RTP) at the line level when a HCPCS code is reported with modifiers 93 or 95 that is not on the CMS Telehealth list.
Additionally, a new Line Item Action Flag (LIAF) value of 7 (Preventive telehealth service with coinsurance and/or deductible waived) has been added to identify preventive services performed via telehealth to receive a waiver of coinsurance and/or deductible. Note: This will not be activated for FQHC and RHC clinics until October 1, 2026.
Skin Substitute Editing and Processing¶
Pass-through skin substitute products with a Status Indicator (SI) of G have been retroactively included in the criteria for Edit 87 (effective October 1, 2019).
CMS has also introduced Edit 140, which will return the claim to the provider (RTP) at the line level when a non-BLA skin substitute product is reported with modifier JW or JZ.
Contractor Bypass and Mid-Quarter HCPCS Conversions¶
To streamline mid-quarter HCPCS conversions, Edit 141 has been added as an informational-only edit (sets Line Item Denial/Rejection flag to 3). This applies to HCPCS reported on or after a mid-quarter effective date with a bypassed or converted SI and/or APC applied by MAC-directed conversion.
Contractor Bypass Automation Templates have also been updated to include Line Item Action Flag and Edit_Output (1-4) requirements.
CAH Medical Visit Processing¶
Edit 21 logic has been updated for Critical Access Hospital (CAH) claims (bill type 85x). The edit is now bypassed when a medical visit (SI of J2 or V) is reported with a professional services revenue code (096x, 097x, 098x) on the same service date as a procedure (SI of J1, S, or T) that is reported with a facility revenue code.
Advance Care Planning¶
Advance Care Planning (ACP) logic has been corrected to retain a Status Indicator of A when an ACP service is reported on the same claim as an Annual Wellness Visit (AWV) and a CAPC procedure (SI = J1). This ensures the ACP is treated as a preventive service when performed in conjunction with the AWV.
[!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.