CY 2026 Stark Law Designated Health Services Code List Update and Brief User Guide

On December 1, 2025, the Centers for Medicare & Medicaid Services (“CMS”) published its annual update to the Designated Health Services (DHS) code list (“DHS List”). A 30-day comment period for the update is open until December 31, 2025.

As in prior years, CMS’s update to the DHS List both removes and adds Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes that fit within certain categories defined as DHS under 42 C.F.R. § 411.351.

When a CPT or HCPCS code is considered DHS, the service falls within the ambit of the federal physician self-referral law (commonly called the “Stark Law”). 

As a strict liability statute, compliance with the Stark Law is a key issue for any physician or entity that furnishes and bills Medicare for DHS that has financial relationships with the physicians who refer for those services.

The Stark Law is a complicated statute, and its nuances are beyond the scope of this article. However, changes to the DHS List can have a direct impact on compliance if not carefully monitored.  These changes may require providers to update internal systems to ensure they appropriately capture DHS codes for various needs, including physician compensation.

For the fourth year, CMS has published the DHS List on its List of CPT/HCPCS Codes website (https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes) rather than through the Federal Register.   If anyone wishes to write comments about this list, the directions on the site state: “. . . go to www.regulations.gov and enter the docket number “CMS-2025-0932” in the search field. Select the “Comment” button and follow the instructions.”

Below, we provide a brief tutorial on how to read the DHS List and insights on the changes made for CY 2026.

What are Designated Health Services (DHS)? 

Under 42 C.F.R. § 411.351, CMS defines DHS to include 10 categories of services: 

• Clinical laboratory services.

• Physical therapy, occupational therapy, and outpatient speech-language pathology services. 

• Radiology and certain other imaging services.

• Radiation therapy services and supplies.

• Durable medical equipment and supplies.

• Parenteral and enteral nutrients, equipment, and supplies.

• Prosthetics, orthotics, and prosthetic devices and supplies.

• Home health services.

• Outpatient prescription drugs.

• Inpatient and outpatient hospital services.

The DHS List, published in both a text document and an excel file, only addresses the four (first) categories. For these four categories, a CPT/HCPCS code is considered DHS only if it is included on the list, either individually or through a descriptive rule. Codes not on the list are not considered DHS, even if they seem related to one of these categories.

The remaining 6 categories are not defined by the DHS List and are definitional in nature. CPT and HCPCS codes that fall into one of the 6 other categories need to be evaluated on a case-by-case basis to determine if they are DHS. 

CMS does provide a file that includes all of the year-over-year changes to the DHS List, which can be found at the following website: https://www.cms.gov/files/document/annual-update-list-cpt-hcpcs-codes-effective-january-1-2026.pdf

How Do I Read the DHS List? 

Once you have downloaded the latest list from CMS’s website, determining if a CPT code is considered DHS requires more than a simple search.  It is very important to read the specific language under each category, as some CPT codes may be included or excluded based on descriptive rules rather than being individually listed.

To illustrate how to read the DHS List, we use the Clinical Laboratory Services category as an example. 

Under the Clinical Laboratory Services section of the DHS List there is language that states: “INCLUDE CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT codes for the following blood component collection services:” 

This means that all 80000 series codes are included, UNLESS, specifically excluded when listed under this subheading. 

For CY 2026, 11 CPT codes that would otherwise be included as 80000-series codes are excluded because they are considered blood component collection services. Therefore, for CY 2026, all 80000-series codes are DHS except for these 11 expressly excluded codes.

Note, this is a change from CY 2025, where 13 CPT codes were excluded because they were considered blood component collection services .  Specifically, CPT Codes 86152 and 86153 were removed from the “EXCLUDE” list, making them DHS for CY 2026.

CMS then includes a subset of codes that it deems to be Clinical Laboratory Services under the heading: “INCLUDE the following CPT and HCPCS codes for other clinical laboratory services:”

These are codes outside of the 80000 CPT code series that CMS has designated as Clinical Laboratory Services and thus DHS. 

In CY 2026 there are 615 such CPT codes, while in 2025 there were only 348.  For CY 2026 there were actually 15 deletions from this category and 282 additions to get to the total of 615. 

For the other three categories-(i) physical therapy, occupational therapy, and outpatient speech-language pathology (“PT/OT/SLP”) services; (ii) radiology and certain other imaging services; and (iii) radiation therapy services and supplies-the DHS List specifically itemizes the codes that CMS considers DHS.  Thus, if there is a radiology imaging service (like certain x-rays) that do not appear on the DHS List, it may be one of the specific radiology services that CMS has chosen not to treat as a DHS.

CMS also uses the DHS List to enumerate certain CPT/HCPCS DHS codes that qualify for exceptions like the preventive screening tests and vaccines exception under § 411.355(h). The list of codes for preventive tests and vaccines under § 411.355(h) often changes year-to-year. The DHS List also includes a section for the EPO and Other Dialysis-Related Drugs exception under § 411.355(g), though no codes have been listed in this section for at least a decade. 

Codes found under these exception sections are still DHS, but they may be permissible under the Stark Law if the service meets requirements of the applicable exception. For example G0103, a Prostate Specific Antigen screening, is included as a non-80000-series Clinical Laboratory Service and also appears under the section for Preventive Screening Tests and Vaccines. Thus, it is both a DHS and eligible for the exception under § 411.355(h).

Common Mistakes 

A common mistake is to simply search a specific CPT/HCPCS code, not find it explicitly listed, and assume it is not DHS. For example, the surgical pathology code CPT “88305” does not appear individually on the DHS List but is DHS because of the language including all 80000-series codes unless specifically excluded. Similarly, a code could be DHS if it falls into one of the 6 categories not addressed by the DHS List.

As described above, changes occur annually, so a code considered non-DHS in 2025 may become DHS in 2026 (and vice versa). For example, CPT Code 0005U is newly designated as DHS for CY 2026.

Other Notable Changes in the DHS List for CY 2026

While it is important for providers to review all annual changes, the following are a few notable updates:

1) Addition of three more Remote Therapeutic Monitoring codes to the PT/OT/SLP Services list: 

• 98979 - Rtm tx mgmt 1st 10 min

• 98984  - Rtm dev sply resp sys 2-15 d

• 98985  - Rtm dev sply mscsk sys 2-15d

2) Addition of 30 radiology services and other imaging codes, and removal of only one: 

• 0042T  - Ct perfusion w/contrast cbf

3) Re-categorization of some codes from Clinical Laboratory Services to Radiology and Other Imaging Services, which maintains the following codes as DHS, just under a new category:

• 0640T  - Ncntc ifr spctrsc o/t pad 1    

• 0859T  - Ncntc ifr spctrsc o/t pad ea   

• 0860T  - Ncntc ifr spctrsc scr pad       

How Does Katten Review DHS? 

Katten’s healthcare team, in collaboration with Katten’s DataLab team (which includes Katten's data scientists), has developed a proprietary system to analyze CPT/HCPCS code lists for our clients. This system can efficiently identify which codes are potentially DHS, in which years they are/were DHS, and whether a code is eligible for an exception. This tool is a valuable asset during due diligence, compliance reviews, and self-disclosures related to the Stark Law (Self-Referral Disclosure Protocol or SRDP), allowing for the rapid identification of potential compliance issues.