New Technology Add-On Payment (NTAP) Updates for FY 2027

New Technology Add-on Payments or NTAPs represent a significant source of potential reimbursement for hospitals. As such, coders should make it a priority to recognize and assign the codes that report devices, substances and technologies approved for new technology add-on payment.

What are New Technology Add-On Payments?

For new services or technologies to be considered for new technology add-on payment, three criteria must be met. The technology must be new, it must be costly such that the DRG rate is determined to be inadequate, and it must demonstrate a substantial clinical improvement over existing services or technologies.

For those services and technologies that meet the new technology criteria, CMS provides incremental payment in addition to the DRG payment.

For FY 2027 Medicare will make an add-on payment equal to the lesser of

• 65% of the costs of the new medical service or technology or
• 65% of the amount by which the cost of the case exceeds the standard DRG payment

Additionally, certain services/technologies may be approved by Medicare for an increase in payment amount from 65% to 75%.

NTAPs Approved for FY 2027

For FY 2027 there are a total of 60 new services and technologies that have been approved for NTAP.

The three new technologies approved for NTAP for 2027 under the Traditional Pathway have significant NTAP payment amounts. They include:

• GAMIFANT® - An intravenous infusion indicated in the treatment of adult and pediatric (newborn and older) patients with hemophagocytic lymphohistiocytosis (HLH)/MAS in known or suspected Still's disease. The maximum NTAP payment a hospital can receive for administration of GAMIFANT® is $672,756.50

• YARTEMLEA® - A fully human monoclonal antibody designed to treat and alleviate the detrimental consequences of hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA). The maximum NTAP payment a hospital can receive for use of YARTEMLEA® is $287,079.00.

• ZEVASKYN™ - An autologous cell sheet-based gene therapy which contains functional copies of the collagen type VII alpha 1 chain (COL7A1) transgene for the treatment of adult and pediatric patients with recessive dystrophic epidermolysis bullosa (RDEB). The maximum NTAP payment a hospital can receive for use of ZEVASKYN™ is $2,045,550.00

Several technologies approved for NTAP in 2025 and 2026 continue to be eligible for significant NTAP reimbursement. These include:

• CASGEVY™ ($1,650,000.00)
• LYFGENIA™ ($2,325,000.00)
• BREYANZI® ($316,860.05)
• TECELRA® ($472,550.00)

Recognizing the substantial reimbursement amounts associated with these technologies underscores the importance of being diligent in capturing every NTAP approved procedure. Every code counts!

Getting it Right

Correctly capturing NTAP revenue requires knowing something about what NTAP procedures are and what they are not. For example, not every code in the New Technology section of ICD-10-PCS is an NTAP approved procedure. Additionally, although NTAP procedures can come from the New Technology section, codes with NTAP can also come from other sections of ICD-10-PCS, such as the Medical and Surgical or Administration sections. Coders need to be careful not to assign codes from the wrong section when reporting NTAP procedures. For example, don’t assign a code from the Administration section of ICD-10-PCS with the root operation of Introduction for administration of a substance that should be more specifically reported with a specific New Technology code that qualifies for NTAP.

Example: Administration of GAMIFANT® into a peripheral/central vein is reported with code from table XW0 from the New Technology section of ICD-10-PCS,

rather than code table 3E0 from the Administration section of ICD-10-PCS.

Prepare Now

Make sure you and your team are ready on October 1, 2026, to capture all NTAP approved substances, devices and technologies.

To assist you in identifying all technologies that have been approved for NTAP for FY 2027, including a description of the technology, the relevant diagnosis and procedures codes and the maximum payment organizations can receive for these procedures, purchase our downloadable guide to FY 2027 New Technology Add-On Payments.

References

• FY 2027 IPPS Final Rule 1849-F

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.