In the CY 2026 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) finalized a national payment rate for CPT code 0583T (tympanostomy using an automated tube delivery system with iontophoresis local anesthesia), agreeing with stakeholder feedback that the resource use and intensity of CPT code 0583T are comparable to CPT code 31295 (nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa) for physician work, time, and direct practice expense inputs. In the final rule, CMS asserts that a national price for CPT 0583T “will improve patient access to the procedure and align with time and resources involved, ensuring accurate payment for practitioners performing this procedure in the office setting.”
CMS also maintained contractor pricing for +G0561 (tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with a tympanostomy tube delivery device, unilateral), which means that the value of this code will be determined by Medicare Administrative Contractors (MACs), commercial payers, or Medicaid plans rather than by a national CMS-set value. CMS agrees with stakeholders that it may be beneficial to collect more data on the use of HCPCS G0561 prior to proposing national pricing and acknowledging the American Medical Association (AMA) Relative Value Scale Update Committee (RUC)’s plan to review CPT codes 0583T, 69433, and G0561 in future code valuation efforts. Additional information will be shared with Academy members as future coding changes are implemented.
