Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
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AHA Coding Clinic® for HCPCS - 2014 Issue 2; For your information
Topical application of mitomycin during or following ophthalmic surgery
CMS has instructed hospital outpatient departments to only report HCPCS code J7315, Mitomycin, ophthalmic, 0.2 mg, or HCPCS code J3490, Unclassified drugs, for the application of mitomycin during or following ophthalmic surgery. It will only be appropriate for the hospital to report HCPCS J7315 if the hospital uses mitomycin with the trade name Mitosol®. All other topical mitomycin should be reported with HCPCS code J3490. Please note: HCPCS code J9280, Injection, mitomycin, 5 mg, should not be reported by hospital outpatient departments for the topical application of mitomycin.
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