For 2026- CMS has changed some of their reimbursement rates for Inpatient CART-T treatments.

For FY 2026- there was an increase in MS-DRG 018 reimbursement 16.8% that will equate to $314,231.

For high cost outlier cases the payment was decrease 13% and will be $40,397.

The clinical trial reimbursement: the finalized payment was decreased by 43% – $50,277.

New Technology Add on payment- FY 2026 was approved for 2 CART-T biologics only:

• Liso-cel (BREYANZI®), a CAR-T treating chronic lymphocytic leukemia or small lymphocytic lymphoma. The max reimbursement is $316,860
• Afamitresgene autoleucel (TECELRA®), an autologous T-cell receptor therapy for the treatment of advanced synovial sarcoma- the max amount will be $472,550

Find this type of information useful? Follow my blog for more reimbursement news!

• CMS CART-T reimbursement for FY 2026
• GA:UnitedHealthcare HMO or (HDHP) plan- weight-loss meds prior auth
• UHC New Mexico Community Plan- new payer ID
• Cigna Pathwell Specialty medications updates
• MVP: proper TOB is required for OASAS providers

Coming soon! CART-T Medical Billing and Coding Reference guide!