An operational control plan for loading and validating October 2026 Medicare Part B ASP and NOC pricing files, plus reviewing claims affected by prior-quarter revisions.
CMS's October 2026 quarterly update makes the new Average Sales Price and Not Otherwise Classified drug pricing files effective for dates of service from October 1 through December 31, 2026. The same instruction also provides revised files for earlier quarters. That makes this more than a fee-schedule download: revenue-cycle teams need one control for new October claims and another for older claims whose payment limits may have changed.
Use the date of service as the pricing control
CMS instructs Medicare contractors to use the October 2026 ASP and NOC pricing files for dates of service from October 1 through December 31, 2026. The relevant quarter follows the service date, not the date a claim is created, transmitted, or adjudicated.
Operationally, the billing system should load the October files before releasing October drug claims. A focused validation should confirm the HCPCS code, billed units, applicable NOC support, and expected allowance. Those checks do not replace coverage or coding review; they isolate whether a variance is actually caused by pricing.
Do not recalculate CMS's published allowance
The change request says the pricing files contain the payment allowance limits and contractors should not make additional calculations. Depending on the drug and available data, those limits may reflect 106 percent of ASP, 106 percent of wholesale acquisition cost, or 95 percent of average wholesale price.
For practices, the practical control is reconciliation. Compare the first October remittances with the published allowance and the exact date of service. Record mismatches by code, units, payer response, and claim status so configuration issues are separated from coding, unit, medical-necessity, and coverage denials.
Create a prior-quarter revision queue
CMS also directs contractors to use revised July, April, and January 2026 files and a revised October 2025 file when they process or reprocess claims on or after October 1. That means an October implementation can affect claims with older dates of service.
Download the revised files, identify material changes in codes your organization billed, and match them to affected claims. Review the original allowance, paid amount, adjustment history, and remaining appeal or reopening options before deciding whether action is warranted.
The practical takeaway
Quarterly drug pricing should produce two owned work queues: a current-quarter validation queue and a prior-quarter revision queue. Assign the file load, payment reconciliation, exception review, and closure evidence to named owners.
Official guidance establishes which files apply. Revenue-cycle leadership must make sure each claim uses the correct quarter and that payment is checked against the published limit before small pricing errors spread across a full quarter.
Practical takeaway
Match the Medicare Part B drug pricing file to the date of service, not the claim submission date.
Validate the first October remittances against the published allowance before a configuration error spreads.
Create a separate review queue for claims affected by revised prior-quarter pricing files.